NPIMap

Organization Active NPI

Jim Wallace & Associates, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Edmond, OK
National Provider Identifier
1073831350
Registry record updated May 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
JIM WALLACE & ASSOCIATES, INC
Practice address
1320 E 9TH St Ste 4
Edmond, OK 73034-5773
Phone
(405) 665-4385
Fax
(405) 665-6396
NPI assigned
May 11, 2010
Organization subpart
Yes
Parent organization
JIM WALLACE & ASSOCIATES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Teresa Gale Rue-Wallace, MASTERS SCIENCE
Title
Owner/Ceo/President/Exec. Director
Phone
(405) 665-4385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1320 E 9TH St Ste 4
Edmond, OK 73034-5773

Mailing address

202 S Washita Ave
Wynnewood, OK 73098-7820
Phone (405) 665-4385

Other identifiers 1

IdentifierTypeStateIssuer
100749080MedicaidOK

Other names 1

  • The Jetty Counseling Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jim Wallace Associates Inc8 organizations share this tax ID, including this one
Part of
Jim Wallace Associates Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1320 E 9th St
Ste 4
Edmond, OK 73034
Phone (405) 665-4385

1340 N Eastern Ave
Moore, OK 73160
Phone (405) 517-7679

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748649600000",
    "number": "1073831350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S WASHITA AVE",
            "city": "WYNNEWOOD",
            "state": "OK",
            "postal_code": "730987820",
            "telephone_number": "405-665-4385",
            "fax_number": "405-665-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 E 9TH ST STE 4",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730345773",
            "telephone_number": "405-665-4385",
            "fax_number": "405-665-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM WALLACE & ASSOCIATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JIM WALLACE & ASSOCIATES, INC",
        "enumeration_date": "2010-05-11",
        "last_updated": "2025-05-31",
        "certification_date": "2025-05-31",
        "status": "A",
        "authorized_official_last_name": "RUE-WALLACE",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "GALE",
        "authorized_official_title_or_position": "OWNER/CEO/PRESIDENT/EXEC.  DIRECTOR",
        "authorized_official_telephone_number": "405-665-4385",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MASTERS SCIENCE"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749080",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Jetty Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Jetty Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.