Provider Demographics
NPI:1134269202
Name:WILSHIRE, THEA W (PHD)
Entity type:Individual
Prefix:DR
First Name:THEA
Middle Name:W
Last Name:WILSHIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SOUTH THIRD ST.
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501
Mailing Address - Country:US
Mailing Address - Phone:928-200-8733
Mailing Address - Fax:928-475-4880
Practice Address - Street 1:630 SOUTH THIRD ST.
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-200-8733
Practice Address - Fax:928-475-4880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3578103T00000X
AZAZ3578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist