Paul Eugene Goddard, PH.D. – Clinical Psychologist

Key facts

NPI: 1598096521
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Psychologist 103TC0700X
License: 308846-2501 (UT)
Practice address: 2711 Santa Clara Dr
Suite 200
Santa Clara, UT 84765-5466
Phone: (435) 674-9310
Fax: (435) 674-9309
NPI assigned: Jan 14, 2010
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Second Nature Entrada LLC Adolescent and Children Mental Health Clinic/Center · Santa Clara, UT · NPI 1063692804

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
308846-2501	UT	MD	Clinical Psychologist

Practice roles

Organization	Specialty	Status	New patients
Second Nature Entrada LLC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Psychologist	103TC0700X	308846-2501	UT	Yes

Addresses

Primary practice location

2711 Santa Clara Dr
Suite 200
Santa Clara, UT 84765-5466

Mailing address

2711 Santa Clara Dr
Suite 200
Santa Clara, UT 84765-5466
Phone (435) 674-9310

Other providers in Santa Clara, UT

All providers in Santa Clara, UT · Clinical Psychologist in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.