Healthcare Provider Details

I. General information

NPI: 1407578263
Provider Name (Legal Business Name): GRAVIDA PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 E QUEEN AVE STE 111C
SPOKANE WA
99207-1430
US

IV. Provider business mailing address

4402 W ELDERBERRY AVE
SPOKANE WA
99208-9438
US

V. Phone/Fax

Practice location:
  • Phone: 509-596-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL COLVER
Title or Position: DIRECTOR
Credential:
Phone: 801-717-6238