Change Academy at Lake of the Ozarks

NPI #1760199244 in Ashburn, Virginia

Provider Information

NPI Number: 1760199244
Entity Type: Organization
Organization Name: Change Academy at Lake of the Ozarks
Subpart: Yes (part of a larger organization)
Parent Organization: CHANGE ACADEMY AT LAKE OF THE OZARKS
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Nov 3, 2022
Last Updated: May 21, 2025

Practice Location

Address: 20116 ASHBROOK PL STE 110
City: Ashburn
State: Virginia
ZIP Code: 20147-5086
Phone: (480) 660-8757

Authorized Official

Name: SHARNELL SPENCER
Title: CREDENTIALING MANAGER
Phone: (661) 239-6923

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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