Provider Demographics
NPI:1104676519
Name:BLUNCK, AMY (CMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BLUNCK
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E 4600 S STE 150534
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3079
Mailing Address - Country:US
Mailing Address - Phone:801-644-0981
Mailing Address - Fax:
Practice Address - Street 1:1742 ROSS DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3242
Practice Address - Country:US
Practice Address - Phone:801-644-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9511459-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health