Provider Demographics
NPI:1356096986
Name:ROSE CITY THERAPEUTICS LLC
Entity type:Organization
Organization Name:ROSE CITY THERAPEUTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROCOUNSELOR AND BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMS
Authorized Official - Middle Name:ANSEL
Authorized Official - Last Name:MARKOVICS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, PHD
Authorized Official - Phone:503-563-3090
Mailing Address - Street 1:170 E FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2110
Mailing Address - Country:US
Mailing Address - Phone:585-770-0691
Mailing Address - Fax:
Practice Address - Street 1:7140 SW FIR LOOP STE 125
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8021
Practice Address - Country:US
Practice Address - Phone:503-563-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1508457904Medicaid