| Grassroots Therapy Group Llc | |
|
1212 N Washington St Ste 204 Spokane WA 99201-2401 | |
| (509) 279-8838 | |
| (509) 267-2717 |
| Full Name | Grassroots Therapy Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1212 N Washington St Ste 204, Spokane, Washington |
| Authorized Official Name and Position | Lori Eastep (CO-OWNER) |
| Authorized Official Contact | 5092798838 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grassroots Therapy Group Llc 1212 N Washington St Ste 204 Spokane WA 99201-2401 Ph: (509) 279-8838 | Grassroots Therapy Group Llc 1212 N Washington St Ste 204 Spokane WA 99201-2401 Ph: (509) 279-8838 |
| NPI Number | 1215379086 |
|---|---|
| Provider Enumeration Date | 07/22/2013 |
| Last Update Date | 08/05/2025 |
| Certification Date | 08/05/2025 |
| Medicare PECOS PAC ID | 5092247429 |
|---|---|
| Medicare Enrollment ID | O20241010001009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215379086 | NPI | - | NPPES |
| 2041978 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lori Jean Eastep |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952650111 PECOS PAC ID: 9537691969 Enrollment ID: I20241015002676 |
| Provider Name | Sandra Gormon-brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154696086 PECOS PAC ID: 1850837956 Enrollment ID: I20241211002456 |
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