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General NPI Number Information
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NPI Number | 1366036840
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Entity Type | Organization
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Legal Business Name | ROSE CITY THERAPISTS LLC
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 3434 S KELLY AVE
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City | PORTLAND
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State | OR
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Zip | 97239-4630
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Country | US
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Telephone | 503-908-3012
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Fax | 503-908-2382
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Provider Business Mailing Address
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Address Line | 3747 SE MORRISON ST
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City | PORTLAND
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State | OR
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Zip | 97214-3209
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Country | US
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Telephone | 503-908-3012
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Fax | 503-908-2382
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PATRICK GLUZINSKI
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Credential |
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Telephone | 503-908-3012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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