Provider Demographics
NPI:1215379086
Name:GRASSROOTS THERAPY GROUP LLC
Entity type:Organization
Organization Name:GRASSROOTS THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTEP
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-279-8838
Mailing Address - Street 1:1212 N WASHINGTON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2401
Mailing Address - Country:US
Mailing Address - Phone:509-279-8838
Mailing Address - Fax:509-267-2717
Practice Address - Street 1:1212 N WASHINGTON ST STE 204
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2401
Practice Address - Country:US
Practice Address - Phone:509-279-8838
Practice Address - Fax:509-267-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QM0801X
WALW601858851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041978Medicaid