Provider Demographics
NPI:1134291636
Name:MCQUEEN, MARC H (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:H
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N BIG SPRING ST
Mailing Address - Street 2:STE 325
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-570-1084
Mailing Address - Fax:432-570-4069
Practice Address - Street 1:1004 N BIG SPRING ST
Practice Address - Street 2:STE 325
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-570-1084
Practice Address - Fax:432-570-4069
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14525101YP2500X
TX004772-042983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist