AGATE MOON ECOTHERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKER, INC
NPI 1407546989
Clinic/Center - Mental Health (Including Community Mental Health Center) in Mckinleyville, CA

Q: What is Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Active since May 09, 2023

1776 MARKET AVE, MCKINLEYVILLE, CA 95519(503) 440-5924 Get Directions Write a Review

NPPES record last updated: May 10, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGATE MOON ECOTHERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKER, INC (NPI 1407546989) is a healthcare organization registered as a mental health (including community mental health center) in Mckinleyville, California and active in the NPI registry since May 2023. The organization lists Bo Jason Hamer, Ceo - Clinical Director, as its authorized official.

NPPES Registry Identity

NPI1407546989

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NameAGATE MOON ECOTHERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKER, INC

Location Address1776 MARKET AVEMckinleyville, CA 95519-4209

Mailing Address1776 Market AveMckinleyville, CA 95519-4209

Phone(503) 440-5924

Organization SubpartNo

Authorized OfficialBo Jason HamerCeo - Clinical Director · (503) 440-5924

Enumeration DateMay 9, 2023

Last NPPES UpdateMay 10, 2023

NPPES CertifiedMay 10, 2023

✔ NPI 1407546989 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X

1776 MARKET AVE, Mckinleyville, CA 95519

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc's NPI number?

The NPI number for Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc is 1407546989. It was assigned to this organization in the NPPES registry on May 9, 2023.

Where is Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc located?

Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc is located at 1776 Market Ave, Mckinleyville, CA 95519. The listed phone number is (503) 440-5924.

What is Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

When was this NPI record last updated?

The NPPES record for Agate Moon Ecotherapy Collective, Licensed Clinical Social Worker, Inc was last updated on May 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.