Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, INC
NPI #1407546989 in Mckinleyville, California
Provider Information
- NPI Number
- 1407546989
- Entity Type
- Organization
- Organization Name
- Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, INC
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- May 9, 2023
- Last Updated
- May 10, 2023
Practice Location
- Address
- 1776 MARKET AVE
- City
- Mckinleyville
- State
- California
- ZIP Code
- 95519-4209
- Phone
- (503) 440-5924
Authorized Official
- Name
- MR. BO JASON HAMER, LCSW
- Title
- CEO - CLINICAL DIRECTOR
- Phone
- (503) 440-5924
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health |
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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