Healthcare Provider Details

I. General information

NPI: 1235064007
Provider Name (Legal Business Name): IOWA TRIBE OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HIGHWAY 33
PERKINS OK
74059-4129
US

IV. Provider business mailing address

501 E HIGHWAY 33
PERKINS OK
74059-4129
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-4363
  • Fax: 405-547-2960
Mailing address:
  • Phone: 405-547-4363
  • Fax: 405-547-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DAWN DAUGHERTY
Title or Position: DIRECTOR OF HEALTH
Credential:
Phone: 405-547-2473