Organization
GRASSROOT PSYCHIATRY AND MENTAL HEALTH CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTINA EZIGBO (ADMINISTRATOR)
(346) 220-3534
Entity
Organization
Contact information
Practice address
101 ELLIOTT AVE W, SUITE 500, SEATTLE, WA 98119-4292
(682) 453-6176
Mailing address
2100 N HWY 360, GRAND PRAIRIE, TX 75050-1011
(682) 214-0636
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/29/2024
Last updated
04/23/2025
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