Provider Demographics
NPI:1154042281
Name:CYGNET PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:CYGNET PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:907-230-2190
Mailing Address - Street 1:3705 ARCTIC BLVD # 406
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5774
Mailing Address - Country:US
Mailing Address - Phone:907-230-2190
Mailing Address - Fax:
Practice Address - Street 1:2804 W NORTHERN LIGHTS BLVD STE 270
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3300
Practice Address - Country:US
Practice Address - Phone:907-230-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)