Healthcare Provider Details

I. General information

NPI: 1043140965
Provider Name (Legal Business Name): PSYNERGY PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E LAUREL AVE
VISALIA CA
93292-3607
US

IV. Provider business mailing address

2447 SANTA CLARA AVE STE 205
ALAMEDA CA
94501-4535
US

V. Phone/Fax

Practice location:
  • Phone: 408-465-8280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CASEY LEE WOODRUFF
Title or Position: SR. CLINICAL ADMIN SERVICES MANAGER
Credential:
Phone: 408-465-8280