Provider Demographics
NPI:1588698716
Name:KAPEL, LAWRENCE BRUCE (PHD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BRUCE
Last Name:KAPEL
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 1:1070 WIGWAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8178
Mailing Address - Country:US
Mailing Address - Phone:702-454-0201
Mailing Address - Fax:702-454-1245
Practice Address - Street 1:1070 WIGWAM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8178
Practice Address - Country:US
Practice Address - Phone:702-454-0201
Practice Address - Fax:702-454-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602031Medicaid
NV002602031Medicaid
R09636Medicare UPIN