Provider Demographics
NPI:1326403379
Name:SECOND NATURE ENTRADA
Entity Type:Organization
Organization Name:SECOND NATURE ENTRADA
Other - Org Name:EVOKE AT ENTRADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-229-5395
Mailing Address - Street 1:2711 SANTA CLARA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5480
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:435-674-9309
Practice Address - Street 1:2711 SANTA CLARA DR STE 400
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5480
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:435-674-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9190382-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty