| Lgtc Group | |
|
1575 Old Bayshore Hwy Ste 205 Burlingame CA 94010-1613 | |
| (669) 254-4852 | |
| (408) 796-1558 |
| Full Name | Lgtc Group |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1575 Old Bayshore Hwy Ste 205, Burlingame, California |
| Authorized Official Name and Position | Eugene Tilman (DIRECTOR OF OPERATION) |
| Authorized Official Contact | 8009132615 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lgtc Group 2542 S Bascom Ave Ste 110 Campbell CA 95008-5541 Ph: (669) 254-4852 | Lgtc Group 1575 Old Bayshore Hwy Ste 205 Burlingame CA 94010-1613 Ph: (669) 254-4852 |
| NPI Number | 1942893953 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 11/29/2022 |
| Certification Date | 11/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942893953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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