Change Academy Lake of the Ozarks

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

2012008387 Issued in MO

Legal business name

CHANGE ACADEMY LAKE OF THE OZARKS

Practice address

130 Calo LN
Lake Ozark, MO 65049-9208

Phone

(866) 753-1373

NPI assigned

Nov 5, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Kim Page

Title

Therapist

Phone

(573) 200-1608

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1790039261",
    "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": "866-753-1373"
        },
        {
            "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": "866-753-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE ACADEMY LAKE OF THE OZARKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "573-200-1608",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "MO",
            "license": "2012008387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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.
• Jean Louise Curtit-Voss, DC

• All providers in Lake Ozark, MO
• Psychiatric Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.