Healthcare Provider Details

I. General information

NPI: 1558232769
Provider Name (Legal Business Name): JAY CHANG AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23332 HAWTHORNE BLVD STE 304
TORRANCE CA
90505-4457
US

IV. Provider business mailing address

PO BOX 422
TORRANCE CA
90508-0422
US

V. Phone/Fax

Practice location:
  • Phone: 424-558-6427
  • Fax:
Mailing address:
  • Phone: 424-558-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149255
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: