Basic Information
| Provider Information | |||||||||
| NPI: | 1790761518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPEL | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 934 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840417135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017737060 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 934 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015461168 | ||||||||
| FaxNumber: | 8015440770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 262442-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | S99751 | 01 | UT | ICAR | OTHER | 638892 | 01 | UT | U002 | OTHER | 004662200 | 01 | UT | RCAR | OTHER | 107032385101 | 01 | UT | U006 | OTHER | 942938348CAP | 01 | UT | U003 | OTHER |