Basic Information
Provider Information
NPI: 1124194725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAPEWELL
FirstName: DAWN
MiddleName: LORRAINE
NamePrefix: MS.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1208
Address2:  
City: MONTROSE
State: CO
PostalCode: 81402
CountryCode: US
TelephoneNumber: 9702523200
FaxNumber: 9702523208
Practice Location
Address1: 195 STAFFORD LANE
Address2:  
City: DELTA
State: CO
PostalCode: 81416
CountryCode: US
TelephoneNumber: 9708748981
FaxNumber: 9708744169
Other Information
ProviderEnumerationDate: 11/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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