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Organization

JIM WALLACE AND ASSOCIATES INC

Active
Other names
The Jetty Counseling Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JAMES E WALLACE (CEO FINANCIAL ADMINISTRATOR)
(405) 665-4385
Entity
Organization

Contact information

Practice address
1201 NW ARLINGTON AVE, SUITE D, LAWTON, OK 73507-6570
(580) 354-1555
(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

Enumeration date
02/20/2007
Last updated
08/22/2020
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