Provider Demographics
NPI:1669259503
Name:MCKEOWN, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MCKEOWN
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 1:579 WADDLE ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5416
Mailing Address - Country:US
Mailing Address - Phone:479-410-7495
Mailing Address - Fax:
Practice Address - Street 1:579 WADDLE ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5416
Practice Address - Country:US
Practice Address - Phone:479-410-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRBT-23-296959106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician