Organization
JIM WALLACE AND ASSOCIATES INCORPORATED
Active
Organization
JIM WALLACE AND ASSOCIATES INCORPORATED
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
202 S WASHITA AVE, WYNNEWOOD, OK 73098-7820
(405) 665-4385
(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
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749080A
—
OK
Enumeration date
02/20/2007
Last updated
09/08/2021
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