Provider Demographics
NPI:1881488229
Name:PAWNEE NATION MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:PAWNEE NATION MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-212-0344
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-0470
Mailing Address - Country:US
Mailing Address - Phone:918-212-0344
Mailing Address - Fax:918-212-4351
Practice Address - Street 1:1204 HERITAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-0470
Practice Address - Country:US
Practice Address - Phone:918-212-0344
Practice Address - Fax:918-212-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility