Provider Demographics
NPI:1356787444
Name:CHEROKEE NATION
Entity type:Organization
Organization Name:CHEROKEE NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR BEHAVIORAL HEALT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-207-4977
Mailing Address - Street 1:1277 SKILL CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6495
Mailing Address - Country:US
Mailing Address - Phone:918-207-4977
Mailing Address - Fax:918-458-6167
Practice Address - Street 1:1277 SKILL CENTER CIR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-6495
Practice Address - Country:US
Practice Address - Phone:918-207-4977
Practice Address - Fax:918-458-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health