# EMBLAZE FAMILY THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881233047
- **Authorized official:** MISS KELLEY LEWIS LMFT (CLINICAL DIRECTOR)
- **Authorized official phone:** (323) 495-6521

## Contact information

- **Practice address:** 16300 CRENSHAW BLVD STE 208C, TORRANCE, CA 90504-1441
- **Practice address phone:** (818) 751-2008
- **Practice address fax:** (866) 219-1310
- **Mailing address:** PO BOX 3228, GARDENA, CA 90247-1428
- **Mailing address phone:** (818) 751-2008
- **Mailing address fax:** (866) 219-1310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2020
- **Last updated:** 01/28/2021