Provider Demographics
NPI:1366036840
Name:ROSE CITY THERAPISTS LLC
Entity type:Organization
Organization Name:ROSE CITY THERAPISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-908-3012
Mailing Address - Street 1:3747 SE MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3209
Mailing Address - Country:US
Mailing Address - Phone:503-908-3012
Mailing Address - Fax:503-908-2382
Practice Address - Street 1:3434 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4630
Practice Address - Country:US
Practice Address - Phone:503-908-3012
Practice Address - Fax:503-908-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty