# MICGRA PSYCH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366255432
- **Authorized official:** ODETTE AMANDA E BUTLER PMHNP (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (206) 905-3600

## Contact information

- **Practice address:** 2375 E CAMELBACK RD STE 600, PHOENIX, AZ 85016-3493
- **Practice address phone:** (206) 905-3600
- **Mailing address:** 555 ANDOVER PARK W STE 200, TUKWILA, WA 98188-3379
- **Mailing address phone:** (206) 905-3600
- **Mailing address fax:** (206) 485-4710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/30/2025
- **Last updated:** 02/04/2026