JIM WALLACE & ASSOCIATES INC NPI 1073831350

NPI Information

NPI: 1073831350
Provider Name: JIM WALLACE & ASSOCIATES, INC

Doing Business As: THE JETTY COUNSELING CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1330 N CLASSEN BLVD STE 301
OKLAHOMA CITY, OK
ZIP 73106
Phone: (405) 665-4385
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JIM WALLACE & ASSOCIATES, INC is a mental health (including community mental health center) clinic center in Oklahoma City, OK. JIM WALLACE & ASSOCIATES, INC NPI is 1073831350. 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:

1330 N CLASSEN BLVD STE 301
OKLAHOMA CITY, OK
ZIP 73106-834
Phone: (405) 665-4385
Fax: (405) 665-6396

The provider's authorized official is Teresa Gale Rue-wallace .
The authorized official title is OWNER/CEO/PRESIDENT/EXEC. DIRECTORDirector and has the following contact phone number (405) 665-4385.

The enumeration date for this NPI number is 5/11/2010 and was last updated on 9/10/2021.

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
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100749080	MEDICAID	OKLAHOMA

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

NPI Synchronization or Removal

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