Provider Demographics
NPI:1124550546
Name:INTERPLAY PC
Entity Type:Organization
Organization Name:INTERPLAY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PAINTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-310-3286
Mailing Address - Street 1:132 E BROADWAY STE 218
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3150
Mailing Address - Country:US
Mailing Address - Phone:970-310-3286
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY STE 218
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3150
Practice Address - Country:US
Practice Address - Phone:970-310-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty