MEDICARE: DESERT ROSE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1821670670	OTHER	OR	NPI TYPE 1

General Provider Information

NPI Number	:	1336024496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT ROSE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1942 NW KEARNEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 NW KEARNEY ST STE 11
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1463
Country	:	US
Telephone Number	:	503-389-0030
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL COUNSELOR ASSOCIATE
Name	:	ABIGAIL BULLOCK
Credential	:
Telephone Number	:	503-319-4782

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	12/11/2025

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Directions to “DESERT ROSE COUNSELING, LLC ” Practice Location

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