Provider Demographics
NPI:1487002408
Name:MANGUS, LEA (PCSW, MSW)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:MANGUS
Suffix:
Gender:F
Credentials:PCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4925
Mailing Address - Country:US
Mailing Address - Phone:307-272-7551
Mailing Address - Fax:
Practice Address - Street 1:125 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2409
Practice Address - Country:US
Practice Address - Phone:307-754-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical