Organization · Type 2 NPI

Jim Wallace & Associates, Inc

Mental Health Clinic/Center (Including Community Mental Health Center) · Edmond, OK

NPI number 1073831350 Active

Practice location

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

Call (405) 665-4385 Map

Fax (405) 665-6396

Mailing address

202 S Washita Ave
Wynnewood, OK 73098-7820

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

Other mental health clinic/center (including community mental health center) providers in Edmond

See all in Edmond →

NPI record

NPI: 1073831350
Entity type: Organization (Type 2)
Issued: May 11, 2010
Last updated: May 31, 2025
Status: Active
Subpart: Yes of Jim Wallace & Associates, Inc

Other names

<unavail>
The Jetty Counseling Center · doing business as
The Jetty Counseling Center · doing business as

Authorized official

Ms. Teresa Gale Rue-Wallace, MASTERS SCIENCE
Owner/ceo/president/exec. Director
(405) 665-4385

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1073831350

Jim Wallace & Associates, Inc's National Provider Identifier is 1073831350, issued on May 11, 2010. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Edmond, OK. The record was last updated on May 31, 2025.