NPIMap

Organization Active NPI

Vitalize a Professional Psychology Corporation

  • Adult Mental Health Clinic/Center
  • Fresno, CA
National Provider Identifier
1215769104
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
VITALIZE A PROFESSIONAL PSYCHOLOGY CORPORATION
Practice address
155 E Shaw Ave Ste 201
Fresno, CA 93710-7619
Phone
(559) 492-1560
Fax
(559) 234-0641
NPI assigned
Aug 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jonathon Baird, PSYDNPI 1568009561
Title
Ceo
Phone
(559) 797-0116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

155 E Shaw Ave Ste 201
Fresno, CA 93710-7619

Mailing address

155 E Shaw Ave Ste 201
Fresno, CA 93710-7619
Phone (559) 492-1560

National Provider Directory

National Provider Directory
Tax ID family
Vitalize a Professional Psychology Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

155 E Shaw Ave
Ste 201
Fresno, CA 93710
Phone (559) 374-2733

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1215769104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 E SHAW AVE STE 201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937107619",
            "telephone_number": "559-492-1560",
            "fax_number": "559-234-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 E SHAW AVE STE 201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937107619",
            "telephone_number": "559-492-1560",
            "fax_number": "559-234-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALIZE A PROFESSIONAL PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-797-0116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.