Organization
CHANGE ACADEMY AT LAKE OF THE OZARKS
Active
Parent organization
CHANGE ACADEMY AT LAKE OF THE OZARKS
Other names
Embark Virtual at Illinois
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHANGE ACADEMY AT LAKE OF THE OZARKS
Authorized official
SHARNELL SPENCER (CREDENTIALING MANAGER)
(661) 239-6923
Entity
Organization
Contact information
Practice address
332 S MICHIGAN AVE STE 900, CHICAGO, IL 60604-4393
(480) 550-9281
Mailing address
5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
(661) 622-4132
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/20/2024
Last updated
05/21/2025
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