Organization · Type 2 NPI

Jim Wallace and Associates Incorporated

Community/Behavioral Health Agency · Wynnewood, OK

NPI number 1982748067 Active

Practice location

202 S Washita Ave
Wynnewood, OK 73098-7820

Fax (405) 665-6396

Specialties and licenses

Taxonomy	Code	License
Community/Behavioral Health Agency Primary	251S00000X	None listed

Community/Behavioral Health Agency: A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day suppo…

27 other providers at this address

NPI record

NPI: 1982748067
Entity type: Organization (Type 2)
Issued: Feb 20, 2007
Last updated: Sep 8, 2021
Status: Active

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) 306-8511

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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.

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About NPI 1982748067

Jim Wallace and Associates Incorporated's National Provider Identifier is 1982748067, issued on Feb 20, 2007. The primary taxonomy on file is Community/Behavioral Health Agency (251S00000X), and the practice location is in Wynnewood, OK. The record was last updated on Sep 8, 2021.