NPIMap

Organization Active NPI

Kickapoo Behavioral Health

  • Substance Use Disorder Rehabilitation Clinic/Center
  • McLoud, OK
National Provider Identifier
1063607117
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
98 Issued in OK
Legal business name
KICKAPOO BEHAVIORAL HEALTH
Practice address
404 North Highway 102
McLoud, OK 74851
Phone
(405) 964-2081
Fax
(405) 964-5677
NPI assigned
Sep 12, 2007
Last updated
Oct 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Wayne Irion
Title
Health Director
Phone
(405) 964-2081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 98 OK Primary

Addresses

Primary practice location

404 North Highway 102
McLoud, OK 74851

Mailing address

407 North Highway 102
McLoud, OK 74851
Phone (405) 964-2081

National Provider Directory

National Provider Directory
Tax ID family
Kickapoo Tribal Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759708800000",
    "number": "1063607117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 NORTH HIGHWAY 102",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "74851",
            "telephone_number": "405-964-2081",
            "fax_number": "405-964-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 NORTH HIGHWAY 102",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "74851",
            "telephone_number": "405-964-2081",
            "fax_number": "405-964-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKAPOO BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A",
        "authorized_official_last_name": "IRION",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "405-964-2081",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "OK",
            "license": "98",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McLoud, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.