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General NPI Number Information
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NPI Number | 1881921948
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Entity Type | Individual
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Provider Name | JEREMY CAPELLO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 2901 MONTOPOLIS DRIVE
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City | AUSTIN
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State | TX
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Zip | 78741
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Country | US
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Telephone | 512-389-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 6846 LA CONCHA PASS
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City | AUSTIN
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State | TX
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Zip | 78749-4253
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Country | US
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Telephone | 512-301-0122
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1834
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License Number State | KS
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