Healthcare Provider Details

I. General information

NPI: 1215683677
Provider Name (Legal Business Name): CHIOKO JULIETTE GREVIOUS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 CORPORATE WAY
SACRAMENTO CA
95831-3888
US

IV. Provider business mailing address

PO BOX 221336
SACRAMENTO CA
95822-8336
US

V. Phone/Fax

Practice location:
  • Phone: 916-639-9274
  • Fax: 916-471-0560
Mailing address:
  • Phone: 916-639-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94027867
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number127290
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: