Provider Demographics
NPI:1881921948
Name:CAPELLO, JEREMY (PHD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:CAPELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 LA CONCHA PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4253
Mailing Address - Country:US
Mailing Address - Phone:512-301-0122
Mailing Address - Fax:
Practice Address - Street 1:2901 MONTOPOLIS DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:512-389-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist