Change Academy At Lake Of The Ozarks
Community/Behavioral Health in Benton, TN. Organization (NPI-2).
NPI number1982425757
StatusActive
Last updated in NPPESMay 21, 2025
Details
- NPI
- 1982425757
- Entity type
- Organization (NPI-2)
- Legal business name
- Change Academy At Lake Of The Ozarks
- Organization subpart
- Yes
- Enumeration date
- Oct 23, 2024
- Certification date
- May 21, 2025
- Last updated
- May 21, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – |
Other names
- Embark Behavioral Health - Th (Other Name)
Practice location
5842 Highway 30Benton, TN 37307-4734
Phone 480-550-9281
Mailing address
5500 Ming Ave Ste 410Bakersfield, CA 93309-4631
Authorized official
Sharnell Spencer
Credentialing Manager
6612396923
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