Organization · NPI-2

Change Academy At Lake Of The Ozarks

Clinic/Center, Mental Health (Including Community Mental Health Center) · Independence, MO

NPI number1063102226
StatusActive
Last updated in NPPESMay 15, 2025

Details

NPI
1063102226
Entity type
Organization (NPI-2)
Legal business name
Change Academy At Lake Of The Ozarks
Organization subpart
Yes
Enumeration date
May 11, 2023
Certification date
May 15, 2025
Last updated
May 15, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Other names

  • Embark Virtual At Missouri (Doing Business As)

Practice location

3205 N Twyman Rd
Independence, MO 64058-3212

Phone 480-550-9281

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Phone 661-622-4132

Authorized official

Sharnell Spencer
Credentialing Manager
6612396923

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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