Healthcare Provider Details

I. General information

NPI: 1821149170
Provider Name (Legal Business Name): MAXIMILLIAN WACHTEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 CHERRY CREEK NORTH DR STE. 170
DENVER CO
80209-3803
US

IV. Provider business mailing address

2942 CENTRAL PARK BLVD
DENVER CO
80238-2829
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-5300
  • Fax: 303-399-5304
Mailing address:
  • Phone: 303-860-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2832
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2832
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2832
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2832
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: