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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