Provider Demographics
NPI:1699981985
Name:MCMANIGAL, CORY LYNN
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LYNN
Last Name:MCMANIGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-0214
Mailing Address - Country:US
Mailing Address - Phone:308-254-0737
Mailing Address - Fax:308-254-6375
Practice Address - Street 1:1023 10TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1611
Practice Address - Country:US
Practice Address - Phone:308-254-0737
Practice Address - Fax:308-254-6375
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)