Provider Demographics
NPI:1275391724
Name:VENTURE MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:VENTURE MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GELDERT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:407-342-8092
Mailing Address - Street 1:8915 SW OXBOW TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6901
Mailing Address - Country:US
Mailing Address - Phone:503-248-7671
Mailing Address - Fax:
Practice Address - Street 1:8915 SW OXBOW TER
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6901
Practice Address - Country:US
Practice Address - Phone:503-248-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty