Organization
JIM WALLACE & ASSOCIATES, INC
Active
Parent organization
JIM WALLACE & ASSOCIATES, INC
Other names
The Jetty Counseling Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
JIM WALLACE & ASSOCIATES, INC
Authorized official
TERESA GALE RUE-WALLACE MASTERS SCIENCE (OWNER/CEO/PRESIDENT/EXEC. DIRECTOR)
(405) 306-8511
Entity
Organization
Contact information
Practice address
301 W MAIN ST STE 103, ARDMORE, OK 73401-6324
(580) 224-2830
(405) 665-6396
Mailing address
202 S WASHITA AVE, WYNNEWOOD, OK 73098-7820
(405) 665-4385
(405) 663-6396
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/20/2021
Last updated
05/31/2025
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