Individual
NATHAN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17710 NE HALSEY ST, PORTLAND, OR 97230-6734
(503) 305-6296
(503) 387-5279
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PROFESSIONALLICENSE
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/29/2025
Last updated
05/04/2026
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