Provider Demographics
NPI:1477718468
Name:COESHOTT, RANDALL W (PSY 22560)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:COESHOTT
Suffix:
Gender:M
Credentials:PSY 22560
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 OAKLAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4349
Mailing Address - Country:US
Mailing Address - Phone:925-639-7768
Mailing Address - Fax:
Practice Address - Street 1:1415 OAKLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4349
Practice Address - Country:US
Practice Address - Phone:925-639-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22560103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TE1100X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth