Organization
JIM WALLACE AND ASSOCIATES INC.
Active
Organization
JIM WALLACE AND ASSOCIATES INC.
Active
Other names
The Jetty Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. 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 618, ARDMORE, OK 73401-6337
(580) 224-2830
(405) 665-6396
Mailing address
202 S WASHITA AVE, WYNNEWOOD, OK 73098-7820
(405) 665-4385
(405) 665-6396
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749080C
—
OK
Enumeration date
02/20/2007
Last updated
06/01/2026
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up