NPIMap

Organization Active NPI

Jim Wallace & Associates Inc

  • Community/Behavioral Health Agency
  • Hugo, OK
National Provider Identifier
1164557492
Registry record updated May 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JIM WALLACE & ASSOCIATES INC
Practice address
1610 W Jackson St
Hugo, OK 74743-5653
Phone
(405) 665-4385
Fax
(405) 665-6396
NPI assigned
Feb 23, 2007
Organization subpart
No

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
Mrs. Teresa G Rue-Wallace
Title
Ceo
Phone
(405) 665-4385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1610 W Jackson St
Hugo, OK 74743-5653

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100749080BMedicaidOK

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

Other organizations with this tax ID 7

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

Locations

119 N Broadway Ave
Ste 7
Ada, OK 74820

1610 W Jackson St
Hugo, OK 74743
Phone (405) 665-4385

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748649600000",
    "number": "1164557492",
    "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": "1610 W JACKSON ST",
            "city": "HUGO",
            "state": "OK",
            "postal_code": "747435653",
            "telephone_number": "405-665-4385",
            "fax_number": "405-665-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM WALLACE & ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "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": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-665-4385",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749080B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Jetty Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hugo, 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.