NPIMap

Organization Active NPI

Magic City Enterprises, Inc

  • Clinical Psychologist
  • Cheyenne, WY
National Provider Identifier
1386819308
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MAGIC CITY ENTERPRISES, INC
Practice address
1780 Westland Rd
Cheyenne, WY 82001-3322
Phone
(307) 637-8869
Fax
(307) 638-0467
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Mandy Jane Liley
Title
Business Manager
Phone
(307) 637-8869

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X WY Primary
Developmentally Disabled Services Day Training Agency 251C00000X
Developmentally Disabled Services Day Training Agency 251C00000X WY

Addresses

Primary practice location

1780 Westland Rd
Cheyenne, WY 82001-3322

Mailing address

1780 Westland Rd
Cheyenne, WY 82001-3322
Phone (307) 637-8869

Other identifiers 3

IdentifierTypeStateIssuer
100132911MedicaidWY
100132912MedicaidWY
100132901MedicaidWY

National Provider Directory

National Provider Directory
Tax ID family
Magic City Enterprises4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447718400000",
    "number": "1386819308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1780 WESTLAND RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013322",
            "telephone_number": "307-637-8869",
            "fax_number": "307-638-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 WESTLAND RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013322",
            "telephone_number": "307-637-8869",
            "fax_number": "307-638-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGIC CITY ENTERPRISES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "LILEY",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "307-637-8869",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": null,
            "primary": true
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "WY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100132911",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100132912",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100132901",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.