MEDICARE: DAVID EDWARD VENZOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	R8976	OR

General Provider Information

NPI Number	:	1366104184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EDWARD VENZOR

Provider Business Mailing Address
First Line	:	PO BOX 12692
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 SW OAK ST STE 303
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2806
Country	:	US
Telephone Number	:	971-258-2807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	03/18/2026

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Directions to “ DAVID EDWARD VENZOR ” Practice Location

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