NPIMap

Organization Active NPI

Change Academy at Lake of the Ozarks

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stafford, TX
National Provider Identifier
1013635085
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CHANGE ACADEMY AT LAKE OF THE OZARKS
Practice address
4800 Sugar Grove Blvd Ste 275
Stafford, TX 77477-2150
Phone
(888) 491-4177
NPI assigned
Aug 16, 2022
Last updated
May 14, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CHANGE ACADEMY AT LAKE OF THE OZARKSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Sharnell Spencer
Title
Credentialing Manager
Phone
(661) 239-6923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

4800 Sugar Grove Blvd Ste 275
Stafford, TX 77477-2150

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631
Phone (661) 622-4132

Other names 1

  • Embark Virtual at Texas Other name

National Provider Directory

National Provider Directory
Tax ID family
Change Academy at Lake of the Ozarks39 organizations share this tax ID, including this one
Part of
Change Academy at Lake of the Ozarks

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

4800 Sugar Grove Blvd
Ste 275
Stafford, TX 77477
Phone (281) 624-8871

NPI Registry JSON

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1013635085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MING AVE STE 410",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933094631",
            "telephone_number": "661-622-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SUGAR GROVE BLVD STE 275",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774772150",
            "telephone_number": "888-491-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE ACADEMY AT LAKE OF THE OZARKS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHANGE ACADEMY AT LAKE OF THE OZARKS",
        "enumeration_date": "2022-08-16",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "SHARNELL",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "661-239-6923"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embark Virtual at Texas",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Embark Virtual at Texas",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stafford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.