Provider Demographics
NPI:1316496466
Name:VITAL EXPERIENCES
Entity type:Organization
Organization Name:VITAL EXPERIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:760-938-5240
Mailing Address - Street 1:5779 W OAK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2337
Mailing Address - Country:US
Mailing Address - Phone:760-938-5240
Mailing Address - Fax:760-998-3508
Practice Address - Street 1:5779 W OAK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2337
Practice Address - Country:US
Practice Address - Phone:760-938-5240
Practice Address - Fax:760-998-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty