NPIMap

Organization Active NPI

Change Academy at Lake of the Ozarks

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bend, OR
National Provider Identifier
1962250415
Registry record updated May 21, 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
63140 Dickey Rd
Bend, OR 97701-9742
Phone
(480) 550-9281
NPI assigned
May 9, 2024
Organization subpart
Yes
Parent organization
CHANGE ACADEMY AT LAKE OF THE OZARKSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 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 Primary

Addresses

Primary practice location

63140 Dickey Rd
Bend, OR 97701-9742

Mailing address

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

Other names 1

  • Embark Virtual at Oregon 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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1962250415",
    "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": "63140 DICKEY RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019742",
            "telephone_number": "480-550-9281"
        }
    ],
    "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": "2024-05-09",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embark Virtual at Oregon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

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