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Active NPI 1063607117 Organization (Entity Type 2)

Kickapoo Behavioral Health

Clinic/Center - Rehabilitation, Substance Use Disorder • Mcloud, OK

About Kickapoo Behavioral Health NPI 1063607117 Summary

Kickapoo Behavioral Health is a verified healthcare organization specializing in Clinic/Center - Rehabilitation, Substance Use Disorder operating in Mcloud, OK. Located at 404 NORTH HIGHWAY 102, this facility provides patient care and medical services under National Provider Identifier (NPI) 1063607117.

Administrative operations and authorized compliance are overseen by Wayne Irion (Health Director).

Facility Location & Contact Primary Location

Facility Address

404 North Highway 102

Mcloud, OK 74851

Telephone 4059642081

Fax 4059645677

Authorized Official Information

Authorized Contact Name

MS. Wayne Irion

Title / Role

Health Director

Official Telephone

4059642081

Facility Classifications & Specialties

Clinic/Center - Rehabilitation, Substance Use Disorder Primary Taxonomy

NUCC Taxonomy Code: 261QR0405X

Definition to come...

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active April 20, 2008

NPI status registered as active in NPPES database

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Updated Practice Location April 20, 2008

Registered at 404 NORTH HIGHWAY 102, MCLOUD, OK 74851 (Tel: 4059642081)

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Updated Business Mailing Address April 20, 2008

Registered at 407 NORTH HIGHWAY 102, MCLOUD, OK 74851 (Tel: 4059642081)

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Organization / Clinic Name Updated April 20, 2008

Operating as KICKAPOO BEHAVIORAL HEALTH

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 20, 2008

Clinic/Center (License #98 in OK)

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Initial NPI Registration & Enumeration September 12, 2007

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1063607117

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: September 12, 2007

Last Update: October 06, 2025

Update or Correct Listing

Mailing Address

407 North Highway 102

Mcloud, OK 74851

Phone: 4059642081

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.