Embark by Calo

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2012040525 Issued in MO

Legal business name

EMBARK BY CALO

Practice address

110 Crossing Drive Suite 1
Lake Ozark, MO 65049

Phone

(573) 365-2221

NPI assigned

Aug 21, 2017

Organization subpart

Yes

Parent organization

CHANGE ACADEMY AT LAKE OF THE OZARKS, LLCAs reported in NPPES

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

Authorized official

Name

Cecily M Mitchell

Title

Director

Phone

(913) 593-6376

Specialties & licenses 1

Addresses

Part of

Change Academy at Lake of the Ozarks

Locations

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1679099725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1810",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "65049",
            "telephone_number": "573-365-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CROSSING DRIVE SUITE 1",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "65049",
            "telephone_number": "573-365-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBARK BY CALO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHANGE ACADEMY AT LAKE OF THE OZARKS, LLC",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CECILY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "913-593-6376"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2012040525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annmarie Davis, RN
• Randall Galen Drake, D.C.
• Mary Ann Duckworth
• Tiffany Duncan-Ash, LPC
• Cibele F.C. Elliott, LPC
• Carissa Lynn Esposito, PTA
• Patricia J Evans, MA
• Brian Eveland, OD
• Allison Lynn Foster
• Kelly K Frisella, O.D.

• Professional Counselor in Lake Ozark, MO
• Providers in Lake Ozark, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; 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.