MEDICARE: VEN MENTAL HEALTH VERO BEACH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC1900X	Counseling Psychologist
3	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1790504553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEN MENTAL HEALTH VERO BEACH, LLC

Provider Business Mailing Address
First Line	:	13917 GOLD CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2359
Country	:	US
Telephone Number	:	402-991-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 20TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5357
Country	:	US
Telephone Number	:	402-991-9630
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VITHYALAKSHMI SELVARAJ
Credential	:	MD
Telephone Number	:	402-991-9630

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	10/08/2024

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