Healthcare Provider Details

I. General information

NPI: 1629972583
Provider Name (Legal Business Name): GENEVIEVE E JERUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95687
US

IV. Provider business mailing address

331 W TURNER RD APT A
LODI CA
95240-0571
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 209-298-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT165479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: