Provider Demographics
NPI:1598096521
Name:GODDARD, PAUL EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:GODDARD
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 1:2711 SANTA CLARA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5466
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:435-674-9309
Practice Address - Street 1:2711 SANTA CLARA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5466
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:435-674-9309
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308846-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical