Provider Demographics
NPI:1699291666
Name:MIU, ADRIANA SUM (PHD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:SUM
Last Name:MIU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:6363 FOREST PARK RD FL 7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5479
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29296103T00000X
TX38182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist