Provider Demographics
NPI:1306037452
Name:MILUM, DIERK
Entity Type:Individual
Prefix:MR
First Name:DIERK
Middle Name:
Last Name:MILUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SW 8TH AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2314
Mailing Address - Country:US
Mailing Address - Phone:806-672-7938
Mailing Address - Fax:
Practice Address - Street 1:112 SW 8TH AVE STE 604
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2314
Practice Address - Country:US
Practice Address - Phone:806-672-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional