Healthcare Provider Details

I. General information

NPI: 1194411413
Provider Name (Legal Business Name): CYGNUS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 PUALEI CIR APT 202
HONOLULU HI
96815-4933
US

IV. Provider business mailing address

3071 PUALEI CIR APT 202
HONOLULU HI
96815-4933
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMMY CHANG
Title or Position: OWNER
Credential:
Phone: 808-271-6279