The Jetty Counseling Center

LBN: Jim Wallace And Associates Inc.
The Jetty Counseling Center is an health care organization with primary practice located at 925 15Th Ave Nw , Ardmore OK 73401-1809. The organization recently has only one registered license in Agencies / Community/Behavioral Health, which is considered as the primary health care specialty. Jim Wallace And Associates Inc. can be contacted via phone (580) 224-2830, or through Rue-Wallace, Teresa Gale via phone (405) 306-8511.

Contact Information

Primary practice address
925 15Th Ave Nw Ardmore OK 73401-1809
Phone: (580) 224-2830
Fax: (405) 665-6396
Website:
Map and Directions
Authorized official contact:
Name: Rue-Wallace, Teresa Gale MASTERS SCIENCE
Phone: (405) 306-8511

Health care specialties

SpecialtyCodeLicense #State
Agencies / Community/Behavioral Health 251S00000X

Profile Details

NPI number 1194860247
LBN Legal business name Jim Wallace And Associates Inc.
DBA Doing business as The Jetty Counseling Center
Authorized official Rue-Wallace, Teresa Gale MASTERS SCIENCE
Entity Organization
Organization subpart 1 No
Enumeration date Feb 20th, 2007
Last updated Sep 8th, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194860247 NPPES
Oklahoma MEDICAID 100749080C

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