Individual
CHARLES T. ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 WINNY AVE., HELENA, MT 59601
(406) 422-0414
(612) 465-1397
Mailing address
2047 N. LAST CHANCE GULCH #167, HELENA, MT 59601
(406) 422-0414
(612) 465-1397
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11196
MT
2084P0800X
Psychiatry Physician
MD60191799
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000914460
BLUE CROSS-SHIELD OF MONTANA
MT
Enumeration date
12/01/2006
Last updated
04/01/2015
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