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General NPI Number Information
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NPI Number | 1881482941
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Entity Type | Organization
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Legal Business Name | LGTC GROUP
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 4850 UNION AVE
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City | SAN JOSE
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State | CA
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Zip | 95124-5156
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Country | US
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Telephone | 800-913-2615
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 UNION AVE
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City | SAN JOSE
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State | CA
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Zip | 95124-5156
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Country | US
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Telephone | 800-913-2615
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YEVGENIY TILMAN
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Credential |
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Telephone | 408-505-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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