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General NPI Number Information
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NPI Number | 1457588170
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Entity Type | Individual
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Provider Name | DR. MAHTAB WILSEY
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Gender | Female
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Dates
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Enumeration Date | 06/20/2009
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Last Update Date | 06/20/2009
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Provider Practice Location Address
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Address Line | 425 S CHERRY ST STE 810
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City | DENVER
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State | CO
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Zip | 80246-1235
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Country | US
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Telephone | 303-215-4515
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Fax | 303-399-6069
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Provider Business Mailing Address
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Address Line | 425 S CHERRY ST STE 810
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City | DENVER
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State | CO
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Zip | 80246-1235
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Country | US
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Telephone | 303-215-4515
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Fax | 303-399-6069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2719
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License Number State | CO
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