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Organization
AGATE MOON ECOTHERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKER, INC
Active
Organization
AGATE MOON ECOTHERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BO JASON HAMER LCSW (CEO - CLINICAL DIRECTOR)
(503) 440-5924
Entity
Organization
Contact information
Practice address
1776 MARKET AVE, MCKINLEYVILLE, CA 95519-4209
(503) 440-5924
Mailing address
1776 MARKET AVE, MCKINLEYVILLE, CA 95519-4209
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/09/2023
Last updated
05/10/2023
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