Provider Demographics
NPI:1336959295
Name:ZICHY-THYSSEN, AMELIE JUSTINE (MFT, CMHC)
Entity type:Individual
Prefix:
First Name:AMELIE
Middle Name:JUSTINE
Last Name:ZICHY-THYSSEN
Suffix:
Gender:F
Credentials:MFT, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 SILVER CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7052
Mailing Address - Country:US
Mailing Address - Phone:949-441-9111
Mailing Address - Fax:
Practice Address - Street 1:7070 S UNION PARK AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4179
Practice Address - Country:US
Practice Address - Phone:801-528-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14193003-6009101YM0800X
UT14193003-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist