Healthcare Provider Details

I. General information

NPI: 1881488229
Provider Name (Legal Business Name): PAWNEE NATION MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 HERITAGE CIRCLE
PAWNEE OK
74058-0470
US

IV. Provider business mailing address

PO BOX 470
PAWNEE OK
74058-0470
US

V. Phone/Fax

Practice location:
  • Phone: 918-212-0344
  • Fax: 918-212-4351
Mailing address:
  • Phone: 918-212-0344
  • Fax: 918-212-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN E KIRK
Title or Position: INTERIM CHIEF OPERATING OFFICER
Credential:
Phone: 918-212-0344