NPIMap

Organization Active NPI

Jim Wallace and Associates Inc

Doing business as The Jetty Counseling Center

  • Community/Behavioral Health Agency
  • Lawton, OK
National Provider Identifier
1760527824
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JIM WALLACE AND ASSOCIATES INC
Doing business as
The Jetty Counseling Center
Practice address
1201 NW Arlington Ave
Suite D
Lawton, OK 73507-6570
Phone
(580) 354-1555
Fax
(405) 665-6396
NPI assigned
Feb 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James E Wallace
Title
Ceo Financial Administrator
Phone
(405) 665-4385

Specialties & licenses 1

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

Addresses

Primary practice location

1201 NW Arlington Ave
Suite D
Lawton, OK 73507-6570

Mailing address

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

Other names 1

  • The Jetty Counseling Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jim Wallace and 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

1201 NW Arlington Ave
Ste D
Lawton, OK 73507
Phone (580) 354-1555

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760527824",
    "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": "1201 NW ARLINGTON AVE",
            "address_2": "SUITE D",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735076570",
            "telephone_number": "580-354-1555",
            "fax_number": "405-665-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM WALLACE AND ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO FINANCIAL ADMINISTRATOR",
        "authorized_official_telephone_number": "405-665-4385",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Jetty Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.