Provider Demographics
NPI:1457588170
Name:WILSEY, MAHTAB
Entity Type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:
Last Name:WILSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MATTY
Other - Middle Name:
Other - Last Name:WILSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:425 S CHERRY ST STE 810
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1235
Mailing Address - Country:US
Mailing Address - Phone:303-215-4515
Mailing Address - Fax:303-399-6069
Practice Address - Street 1:425 S CHERRY ST STE 810
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1235
Practice Address - Country:US
Practice Address - Phone:303-215-4515
Practice Address - Fax:303-399-6069
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical