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JIM WALLACE AND ASSOCIATES INCORPORATED NPI 1164557492


NPI Information

NPI: 1164557492
Provider Name: JIM WALLACE AND ASSOCIATES INCORPORATED

Doing Business As: THE JETTY COUNSELING CENTER

Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
119 N. BROADWAY
SUITE 7
ADA, OK
ZIP 74820
Phone: (580) 310-0860
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JIM WALLACE AND ASSOCIATES INCORPORATED is a community behavioral health in Ada, OK. The provider is 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 support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. JIM WALLACE AND ASSOCIATES INCORPORATED NPI is 1164557492. The provider is registered as an organization entity type.
The provider Is Doing Business As The Jetty Counseling Center.

The provider's business location address is:

119 N. BROADWAY
SUITE 7
ADA, OK
ZIP 74820
Phone: (580) 310-0860
Fax: (405) 665-6396

The provider's authorized official is James E Wallace .
The authorized official title is Ceo Financial Administrator and has the following contact phone number (405) 665-4385.

The enumeration date for this NPI number is 2/23/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251S00000XCommunity/Behavioral HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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