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General NPI Number Information
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NPI Number | 1336959295
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Entity Type | Individual
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Provider Name | AMELIE JUSTINE ZICHY-THYSSEN MFT, CMHC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 7070 S UNION PARK AVE
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City | MIDVALE
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State | UT
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Zip | 84047-4179
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Country | US
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Telephone | 801-528-7309
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Fax |
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Provider Business Mailing Address
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Address Line | 2485 SILVER CLOUD DR
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City | PARK CITY
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State | UT
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Zip | 84060-7052
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Country | US
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Telephone | 949-441-9111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14193003-6009
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 14193003-3904
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License Number State | UT
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