Organization
MAGIC CITY ENTERPRISES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MANDY JANE LILEY (BUSINESS MANAGER)
(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
Primary
—
WY
103TC0700X
Clinical Psychologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
WY
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100132901
—
WY
05
—
100132911
—
WY
05
—
100132912
—
WY
Enumeration date
04/30/2008
Last updated
11/17/2015
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