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General NPI Number Information
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NPI Number | 1639324270
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Entity Type | Organization
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Legal Business Name | MAXIMILLIAN WACHTEL, PH.D., LLC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 3865 CHERRY CREEK NORTH DR SUITE 220
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City | DENVER
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State | CO
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Zip | 80209-3803
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Country | US
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Telephone | 303-399-5300
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Fax | 303-399-5304
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Provider Business Mailing Address
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Address Line | 3865 CHERRY CREEK NORTH DR SUITE 220
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City | DENVER
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State | CO
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Zip | 80209-3803
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Country | US
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Telephone | 303-399-5300
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Fax | 303-399-5304
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. MAXIMILLIAN WACHTEL
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Credential | PH.D
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Telephone | 303-399-5300
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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 | 2832
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License Number State | CO
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