Grassroot Psychiatry and Mental Health Clinic PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

GRASSROOT PSYCHIATRY AND MENTAL HEALTH CLINIC PLLC

Practice address

101 Elliott Ave W, Suite 500
Seattle, WA 98119-4292

Phone

(682) 453-6176

NPI assigned

Jul 29, 2024

Organization subpart

No

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

Authorized official

Name

Martina EzigboNPI 1679285472

Title

Administrator

Phone

(346) 220-3534

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, PA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martina O Ezigbo

  • Psychiatric/Mental Health Nurse Practitioner
  • Seattle, WA
  • NPI 1679285472

  CO, PA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1801625926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N HWY 360",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750501011",
            "telephone_number": "682-214-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ELLIOTT AVE W, SUITE 500",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981194292",
            "telephone_number": "682-453-6176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 N Hwy 360",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750501011",
            "country_code": "US",
            "telephone_number": "682-214-0636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRASSROOT PSYCHIATRY AND MENTAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-29",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "EZIGBO",
        "authorized_official_first_name": "MARTINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "346-220-3534"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ambjorn Granzier-Nakajima, PT
• Molly Gras-Ursy
• Marissa Grasmick, LMHCA
• Miranda P Grasmick
• Kimberly Dawn Grassman
• Jeffrey Gratton, DC
• Kelly Jane Grau, RN
• Jenna Michelle Grauman, LMP
• Kathleen E Graunke, M.D.
• Andrew D Graustein, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.