Provider Demographics
NPI:1164206454
Name:GROUNDED ROOTS FAMILY THERAPY COLLECTIVE AND CONSULTING, INC.
Entity Type:Organization
Organization Name:GROUNDED ROOTS FAMILY THERAPY COLLECTIVE AND CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIOKO
Authorized Official - Middle Name:JULIETTE
Authorized Official - Last Name:GREVIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-639-9274
Mailing Address - Street 1:PO BOX 221336
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-8336
Mailing Address - Country:US
Mailing Address - Phone:916-639-9274
Mailing Address - Fax:
Practice Address - Street 1:6884 23RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4142
Practice Address - Country:US
Practice Address - Phone:916-764-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty