Provider Demographics
NPI:1619145646
Name:HOY-ELLIS, CHARLES PITRE (PHD, MSW, LICSW)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PITRE
Last Name:HOY-ELLIS
Suffix:
Gender:M
Credentials:PHD, MSW, LICSW
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:WAYNE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4007 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-4916
Mailing Address - Country:US
Mailing Address - Phone:206-225-6038
Mailing Address - Fax:
Practice Address - Street 1:4007 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-4916
Practice Address - Country:US
Practice Address - Phone:206-225-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000096011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical