Healthcare Provider Details

I. General information

NPI: 1477226264
Provider Name (Legal Business Name): JONATHAN MCDONALD BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W CAMBRIDGE AVE
VISALIA CA
93277-4513
US

IV. Provider business mailing address

1505 W CAMBRIDGE AVE
VISALIA CA
93277-4513
US

V. Phone/Fax

Practice location:
  • Phone: 559-329-1578
  • Fax:
Mailing address:
  • Phone: 559-329-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250227457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: