Provider Demographics
NPI:1346222130
Name:GOODENOW, LAWRENCE HOWARD (PHD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:HOWARD
Last Name:GOODENOW
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:4448 OAKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5494
Practice Address - Country:US
Practice Address - Phone:810-342-5333
Practice Address - Fax:810-342-1590
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01002469OtherHEALTH PLUS OF MI
1306896956OtherLIST SERVICES GROUP NPI
680B512650OtherBCBSM-BCN-FEP
1962541318OtherMCLAREN PHD GROUP NPI #
G96288055OtherLIST SERVICES MEDICARE ID
MI1018118OtherMCLAREN HEALTH ADVANTAGE
056350OtherVALUE OPTIONS
MI1018118OtherMCLAREN HEALTH PLAN
G96288055OtherLIST SERVICES MEDICARE ID
680B512650OtherBCBSM-BCN-FEP