Agate Bay Professionals Chemical Health Services

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

AGATE BAY PROFESSIONALS CHEMICAL HEALTH SERVICES

Practice address

227 7TH St
Two Harbors, MN 55616-1530

Phone

(218) 830-8085

NPI assigned

Jun 3, 2013

Last updated

Jan 31, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Faith Clark, MSW, LICSW, LADCNPI 1194282160

Title

Counselor & Therapist

Phone

(218) 830-8085

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Faith Clark, MSW, LICSW, LADC

  • Clinical Social Worker
  • Two Harbors, MN
  • NPI 1194282160
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1568809366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 7TH ST",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 7TH ST",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161530",
            "telephone_number": "218-830-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGATE BAY PROFESSIONALS CHEMICAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "COUNSELOR & THERAPIST",
        "authorized_official_telephone_number": "218-830-8085",
        "authorized_official_credential": "MSW, LICSW, LADC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Abbott, MSOT, OTR/L
• Agate Bay Assisted Living LLC
• Debbie Anne Allert, M.D.
• Bradley James Alm, RN
• Stacey Francis Anderson, RDH
• Barross Manor, LLC
• Stephanie Bellrichard, PHARMD

• Substance Use Disorder Rehabilitation Clinic/Center in Two Harbors, MN
• Providers in Two Harbors, MN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.