Healthcare Provider Details

I. General information

NPI: 1891620753
Provider Name (Legal Business Name): JUSTIN CAPELLO M.A, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 N 16TH ST
PHOENIX AZ
85020-5201
US

IV. Provider business mailing address

7719 S 45TH LN
LAVEEN AZ
85339-7322
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-3282
  • Fax:
Mailing address:
  • Phone: 480-406-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-002084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: