NPIMap

Organization Active NPI

Jim Wallace & Associates, Inc

Doing business as The Jetty Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norman, OK
National Provider Identifier
1871263913
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
Doing business as
The Jetty Counseling Center
Practice address
203 Hal Muldrow Dr Ste 4
Norman, OK 73069-5288
Phone
(405) 665-4385
Fax
(405) 663-6396
NPI assigned
Sep 20, 2021
Last updated
May 31, 2025By the provider in NPPES
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
Teresa Gale Rue-Wallace, MASTERS SCIENCENPI 1861723264
Title
Owner/Ceo/President/Exec. Director
Phone
(405) 306-8511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

203 Hal Muldrow Dr Ste 4
Norman, OK 73069-5288

Mailing address

202 S Washita Ave
Wynnewood, OK 73098-7820
Phone (405) 663-4385

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 and Associates Incorporated8 organizations share this tax ID, including this one
Part of
Jim Wallace and Associates Incorporated

Other organizations with this tax ID 7

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

Locations

203 Hal Muldrow Dr
Ste 4
Norman, OK 73069
Phone (405) 217-4547

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748649600000",
    "number": "1871263913",
    "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": "405-663-4385",
            "fax_number": "405-663-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 HAL MULDROW DR STE 4",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730695288",
            "telephone_number": "405-665-4385",
            "fax_number": "405-663-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM WALLACE & ASSOCIATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JIM WALLACE & ASSOCIATES, INC",
        "enumeration_date": "2021-09-20",
        "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": "405-306-8511",
        "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 Norman, 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.