Change Academy Lake of the Ozarks

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

CHANGE ACADEMY LAKE OF THE OZARKS

Practice address

130 Calo LN
Lake Ozark, MO 65049-9208

Phone

(573) 200-1605

NPI assigned

Aug 2, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Michael Koehler, MA

Title

Recreation Therapy Director

Phone

(866) 753-1374

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1343865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1134475635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CALO LN",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "650499208",
            "telephone_number": "573-200-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CALO LN",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "650499208",
            "telephone_number": "573-200-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE ACADEMY LAKE OF THE OZARKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-02",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "RECREATION THERAPY DIRECTOR",
        "authorized_official_telephone_number": "866-753-1374",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Earl Carroll, GENERAL DENTIST
• Shandra L Carter, LCSW
• Change Academy at Lake of the Ozarks
• Change Academy at Lake of the Ozarks
• Change Academy at Lake of the Ozarks
• Change Academy Lake of the Ozarks
• Change Academy Lake Ozark
• Paven Clark
• Angela Sue Creasy, SLP
• Colleen Annette Cueni-Smith, P.T.

• All providers in Lake Ozark, MO
• Emotionally Disturbed Childrens' Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; 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.