Healthcare Provider Details

I. General information

NPI: 1336067982
Provider Name (Legal Business Name): VITALIZE A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 W MINERAL KING AVE
VISALIA CA
93291-5530
US

IV. Provider business mailing address

3742 W MINERAL KING AVE
VISALIA CA
93291-5530
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-0116
  • Fax:
Mailing address:
  • Phone: 559-797-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHON DAVID BAIRD
Title or Position: CEO
Credential: PSYD
Phone: 559-797-0116