Provider Demographics
NPI:1932751286
Name:MCCUEN, MARLON MICHAEL (BS)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:MICHAEL
Last Name:MCCUEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PARK VIEW LN STE 204
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5406
Mailing Address - Country:US
Mailing Address - Phone:304-243-1865
Mailing Address - Fax:
Practice Address - Street 1:111 PARK VIEW LN STE 204
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5406
Practice Address - Country:US
Practice Address - Phone:304-243-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid