Provider Demographics
NPI:1437231933
Name:ENDRES, PAUL R (LP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:ENDRES
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 MIDLAND GROVE RD
Mailing Address - Street 2:#305
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-633-5355
Mailing Address - Fax:
Practice Address - Street 1:4505 WHITE BEAR PKWY
Practice Address - Street 2:SUITE 1800
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-426-8191
Practice Address - Fax:651-426-6766
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0346LP103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist