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General NPI Number Information
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NPI Number | 1356096986
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Entity Type | Organization
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Legal Business Name | ROSE CITY THERAPEUTICS LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 7140 SW FIR LOOP STE 125
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City | TIGARD
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State | OR
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Zip | 97223-8021
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Country | US
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Telephone | 503-563-3093
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Fax |
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Provider Business Mailing Address
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Address Line | 170 E FAIRFIELD ST
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City | GLADSTONE
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State | OR
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Zip | 97027-2110
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Country | US
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Telephone | 585-770-0691
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Fax |
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Authorized Official
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Title or Position | NEUROCOUNSELOR AND BUSINESS OWNER
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Name | JAMS ANSEL MARKOVICS
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Credential | LPC, NCC, PHD
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Telephone | 503-563-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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