Provider Demographics
NPI:1457483927
Name:GOODE, ROBERT LYNTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNTON
Last Name:GOODE
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 1:2035 HOGBACK ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-223-4202
Mailing Address - Fax:734-996-1237
Practice Address - Street 1:2035 HOGBACK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-223-4202
Practice Address - Fax:734-996-1237
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009775103T00000X
MI6301013742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist