Organization · Type 2 NPI

Change Academy at Lake of the Ozarks

Mental Health Clinic/Center (Including Community Mental Health Center) · Southfield, MI

NPI number 1790503324 Active

Practice location

29777 Telegraph Rd Ste 400
Southfield, MI 48034-1303

Call (480) 550-9281 Map

Mailing address

5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

Other mental health clinic/center (including community mental health center) providers in Southfield

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NPI record

NPI: 1790503324
Entity type: Organization (Type 2)
Issued: Oct 2, 2024
Last updated: May 21, 2025
Status: Active
Subpart: Yes of Change Academy at Lake of the Ozarks

Other names

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Embark Virtual at Michigan · other name
Embark Virtual at Michigan · other name

Authorized official

Sharnell Spencer
Credentialing Manager
(661) 239-6923

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1790503324

Change Academy at Lake of the Ozarks's National Provider Identifier is 1790503324, issued on Oct 2, 2024. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Southfield, MI. The record was last updated on May 21, 2025.