NPIMap

Organization Active NPI

Change Academy at Lake of the Ozarks

  • Community/Behavioral Health Agency
  • Benton, TN
National Provider Identifier
1982425757
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CHANGE ACADEMY AT LAKE OF THE OZARKS
Practice address
5842 Highway 30
Benton, TN 37307-4734
Phone
(480) 550-9281
NPI assigned
Oct 23, 2024
Last updated
May 21, 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 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

5842 Highway 30
Benton, TN 37307-4734

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Other names 1

  • Embark Behavioral Health - TH 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

5842 Highway 30
Benton, TN 37307
Phone (423) 375-4173

NPI Registry JSON

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

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1982425757",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5842 HIGHWAY 30",
            "city": "BENTON",
            "state": "TN",
            "postal_code": "373074734",
            "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": "2024-10-23",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embark Behavioral Health - TH",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Embark Behavioral Health - TH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Benton, TN

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.