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Organization
EMBLAZE FAMILY THERAPY INC
Active
Organization
EMBLAZE FAMILY THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KELLEY LEWIS LMFT (CLINICAL DIRECTOR)
(323) 495-6521
Entity
Organization
Contact information
Practice address
16300 CRENSHAW BLVD STE 208C, TORRANCE, CA 90504-1441
(818) 751-2008
(866) 219-1310
Mailing address
PO BOX 3228, GARDENA, CA 90247-1428
(818) 751-2008
(866) 219-1310
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
01/04/2020
Last updated
01/28/2021
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