Provider Demographics
NPI:1427273507
Name:GILCHRIST, RANDY ALLAN I (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ALLAN
Last Name:GILCHRIST
Suffix:I
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2722 LEDGESTONE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8238
Mailing Address - Country:US
Mailing Address - Phone:916-899-4990
Mailing Address - Fax:916-543-4820
Practice Address - Street 1:1899 E ROSEVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7980
Practice Address - Country:US
Practice Address - Phone:916-899-4990
Practice Address - Fax:916-543-4820
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19726103TC0700X
CAMFC 39159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist