Organization
MAGIC CITY ENTERPRISES, INC
Active
Organization
MAGIC CITY ENTERPRISES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MANDY JANE LILEY (VICE PRESIDENT OF BUSINESS SERVICES)
(307) 637-8869
Entity
Organization
Contact information
Practice address
1780 WESTLAND RD, CHEYENNE, WY 82001-3322
(307) 637-8869
(307) 638-0467
Mailing address
1780 WESTLAND RD, CHEYENNE, WY 82001-3322
(307) 637-8869
(307) 638-0467
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
WY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100132901
—
WY
05
—
100132911
—
WY
05
—
100132912
—
WY
Enumeration date
11/08/2006
Last updated
09/17/2020
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