| Organization Name: | KICKAPOO BEHAVIORAL HEALTH |
| NPI Number: | 1063607117 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLA DEAN CROW (SUBSTANCE ABUSE COUNSELOR) |
| Mailing Address: | 404 North Highway 102 Mcloud |
| State: | OK US |
| Postal Code: | 74851 |
| Phone Number: | 4059642081 |
| Fax Number: | 4059645677 |
| NPI Enumeration Date: | 09/12/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 98 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |