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NPI Code Detail

MEDICARE: MIA CHONG LPC-A

MEDICARE: MIA CHONG LPC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor101532TX

General Provider Information

NPI Number : 1730015710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA CHONG LPC-A
Provider Business Mailing Address
First Line : 2808 MCKINNEY AVE APT 231
Second Line :
City : DALLAS
State : TX
Zip : 75204-8673
Country : US
Telephone Number : 918-565-4806
Fax Number :
Provider Business Practice Location Address
First Line : 4222 TRINITY MILLS RD STE 250
Second Line :
City : DALLAS
State : TX
Zip : 75287-7655
Country : US
Telephone Number : 972-534-4288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ MIA CHONG LPC-A” Practice Location

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