Provider Demographics
NPI:1942893953
Name:LOS GATOS THERAPY CENTER
Entity Type:Organization
Organization Name:LOS GATOS THERAPY CENTER
Other - Org Name:LGTC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-913-2615
Mailing Address - Street 1:2542 S BASCOM AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5541
Mailing Address - Country:US
Mailing Address - Phone:669-254-4852
Mailing Address - Fax:408-796-1558
Practice Address - Street 1:1575 OLD BAYSHORE HWY STE 205
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1613
Practice Address - Country:US
Practice Address - Phone:669-254-4852
Practice Address - Fax:408-796-1558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS GATOS THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-19
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health