Organization · NPI-2

Change Academy At Lake Of The Ozarks

Clinic/Center, Mental Health (Including Community Mental Health Center) · Livingston, NJ

NPI number1487499091
StatusActive
Last updated in NPPESMay 21, 2025

Details

NPI
1487499091
Entity type
Organization (NPI-2)
Legal business name
Change Academy At Lake Of The Ozarks
Organization subpart
Yes
Enumeration date
Jun 26, 2024
Certification date
May 21, 2025
Last updated
May 21, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
251S00000X Community/Behavioral Health––

Other names

  • Embark Behavioral Health (Doing Business As)

Practice location

7 Regent St Ste 701
Livingston, NJ 07039-1628

Phone 862-418-4574

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

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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