NPIMap

Organization Active NPI

Jim Wallace and Associates Incorporated

Doing business as The Jetty Counseling Center

  • Community/Behavioral Health Agency
  • Wynnewood, OK
National Provider Identifier
1982748067
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JIM WALLACE AND ASSOCIATES INCORPORATED
Doing business as
The Jetty Counseling Center
Practice address
202 S Washita Ave
Wynnewood, OK 73098-7820
Phone
(405) 665-4385
Fax
(405) 665-6396
NPI assigned
Feb 20, 2007
Last updated
Sep 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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 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
Community/Behavioral Health Agency 251S00000X OK Primary

Addresses

Primary practice location

202 S Washita Ave
Wynnewood, OK 73098-7820

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100749080AMedicaidOK

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

Other organizations with this tax ID 7

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

Locations

301 W Main St
Ste 618
Ardmore, OK 73401
Phone (580) 224-2830

925 15th Ave NW
Ardmore, OK 73401
Phone (580) 223-0011

Practitioners & affiliated clinicians

Practitioners 3

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": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1982748067",
    "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": "202 S WASHITA AVE",
            "city": "WYNNEWOOD",
            "state": "OK",
            "postal_code": "730987820",
            "telephone_number": "405-665-4385",
            "fax_number": "405-665-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM WALLACE AND ASSOCIATES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "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_name_prefix": "Ms.",
        "authorized_official_credential": "MASTERS SCIENCE"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749080A",
            "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 Wynnewood, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.