Provider Demographics
NPI:1588990857
Name:POGUE, MARCUS (MA)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:POGUE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N OAK AVE
Mailing Address - Street 2:ROOM 20
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3267
Mailing Address - Country:US
Mailing Address - Phone:580-332-3001
Mailing Address - Fax:580-332-3652
Practice Address - Street 1:704 N OAK AVE
Practice Address - Street 2:ROOM 20
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3267
Practice Address - Country:US
Practice Address - Phone:580-332-3001
Practice Address - Fax:580-332-3652
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)