MEDICARE: CYGNUS CONSULTATION, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255013942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYGNUS CONSULTATION, LLC.

Provider Business Mailing Address
First Line	:	77 S 700 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 S 700 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1231
Country	:	US
Telephone Number	:	385-528-1108
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	RYAN GARCIA
Credential	:	PH.D.
Telephone Number	:	801-759-5317

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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Directions to “CYGNUS CONSULTATION, LLC. ” Practice Location

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