Provider Demographics
NPI:1265583702
Name:PAINTON, MOLLIE (PSYD)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:PAINTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:970-482-5878
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:970-482-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1801103TC0700X
OR2975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical