The Jetty Counseling Center
LBN: Jim Wallace & Associates, Inc
The Jetty Counseling Center is an health care organization with primary practice located at 301 W Main St Ste 402 , Ardmore OK 73401-6322. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty.
Jim Wallace & Associates, Inc can be contacted via phone (580) 224-2830, or through Rue-Wallace, Teresa Gale via phone (405) 306-8511.
Contact Information
Primary practice address
301 W Main St Ste 402
Ardmore OK 73401-6322
Phone: (580) 224-2830
Fax: (405) 663-6396
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X |
Profile Details
| NPI number | 1871263913 |
|---|---|
| LBN Legal business name | Jim Wallace & Associates, Inc |
| DBA Doing business as | The Jetty Counseling Center |
| Authorized official | Rue-Wallace, Teresa Gale MASTERS SCIENCE |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Sep 20th, 2021 |
| Last updated | Sep 21st, 2021 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871263913 | NPPES |
| Oklahoma | MEDICAID | 100749080 |
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