This was the only Native American deck I ever used. As with all Native American decks, the caveat should be that Native American spirituality is a living tradition of a specific cultural group, and that you aren't receiving an authentic Native American experience, but an appropriated one grafted to fit Tarot. Like Christians to the RWS deck, a Native American is very likely to scorn the use of symbolism acquired for use in a divination tool by a non-Native.
That said, the Vision Quest is an admirable one. The colours are gorgeous, and they certainly picked great choices. The suits are nicely reduced to the basic elements of nature rather than trivializing sacred items like pipes. The family unit, vastly important to indigenous groups, are the subjects of the court cards. Their clothes are not all feathered headdresses and war paints of stereotypcal Indians, and there's an attempt to make the families of each suit look unique, although they all have the appearance of Plains Indians. I absolutely adore the Sun card!
That said, they did accommodate to fit Tarot standards. They separated "Medicine Man" from "Shaman" for I and V, when the two professions are often interchangeable. Depending on your group, shamans--holy people--are also the go-to doctors for phyical illnesses and are connected to the animal and plant world for healing provisions. Many groups also had no Medicine Women. The Small Medicine Wheel's layout is not one adhered to by every group, and Big Medicine Wheel is clearly a Tarot derivative.
The environment focuses on the basic necessities of life and the kinship ties so valued by native groups to their history and pride. In all, it's a good deck that I've used it for dreamwork and guidance before. The LWB is actually a Big WB and is indispensible.
Yay from me.