Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc

LBN: Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc
Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc is an health care organization with primary practice located at 1776 Market Ave , Mckinleyville CA 95519-4209. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty. Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc can be contacted via phone (503) 440-5924, or through Hamer, Bo Jason via phone (503) 440-5924.

Contact Information

Primary practice address
1776 Market Ave Mckinleyville CA 95519-4209
Phone: (503) 440-5924
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Hamer, Bo Jason Licensed Clinical Social Worker (LCSW)
Phone: (503) 440-5924

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X

Profile Details

NPI number 1407546989
LBN Legal business name Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc
DBA Doing business as
Authorized official Hamer, Bo Jason Licensed Clinical Social Worker (LCSW)
Entity Organization
Organization subpart 1 No
Enumeration date May 9th, 2023
Last updated May 10th, 2023 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Popular Providers