Provider Demographics
NPI:1003934001
Name:CAPELL, MARK JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:CAPELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 1200 S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6972
Mailing Address - Country:US
Mailing Address - Phone:801-377-1595
Mailing Address - Fax:801-377-1598
Practice Address - Street 1:313 E 1200 S
Practice Address - Street 2:SUITE 104
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6972
Practice Address - Country:US
Practice Address - Phone:801-377-1595
Practice Address - Fax:801-377-1598
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140095-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical