Provider Demographics
NPI:1225098767
Name:MOY, CHARLENE RUTH (MS LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:RUTH
Last Name:MOY
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KNECHTEL WAY NE
Mailing Address - Street 2:STE. 206
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2860
Mailing Address - Country:US
Mailing Address - Phone:206-930-0695
Mailing Address - Fax:206-842-5444
Practice Address - Street 1:345 KNECHTEL WAY NE
Practice Address - Street 2:STE. 206
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2860
Practice Address - Country:US
Practice Address - Phone:206-930-0695
Practice Address - Fax:206-842-5444
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist