Provider Demographics
NPI:1033253083
Name:ENDRES, ROBERT GREY (DSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GREY
Last Name:ENDRES
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8025 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-2215
Mailing Address - Country:US
Mailing Address - Phone:913-441-0119
Mailing Address - Fax:
Practice Address - Street 1:1508 SW WHITE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2433
Practice Address - Country:US
Practice Address - Phone:816-836-2920
Practice Address - Fax:816-836-2923
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0051521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498290642Medicaid