JIM WALLACE AND ASSOCIATES INCORPORATED (NPI# 1164557492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164557492 |
| Entity Type | Organization |
| Organization Name | JIM WALLACE AND ASSOCIATES INCORPORATED |
| Other Organization Name | THE JETTY COUNSELING CENTER |
| Practice Address |
119 N. Broadway Suite 7 Ada OK 74820 |
| Mailing Address |
202 S Washita Ave Wynnewood OK 73098-7820 |
| Practice Telephone | 5803100860 |
| Practice Fax Number | 4056656396 |
| Mailing Telephone | 4056654385 |
| Mailing Fax Number | 4056656396 |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JAMES E WALLACE (CEO FINANCIAL ADMINISTRATOR) |
| Authorized Official Telephone | 4056654385 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| The Jetty Counseling Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982748067 | Jim Wallace and Associates Incorporated | Community/Behavioral Health | 202 S Washita Ave, Wynnewood, OK 73098-7820 | 2007-02-20 |
| Street Address |
119 N. BROADWAY SUITE 7 |
| City | ADA |
| State | OK |
| Zip Code | 74820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578103727 | Curry Orthopedics and Sports Medicine Pllc | Orthopaedic Surgery | 919 Colony Drive, Ada, OK 74820 | 2020-01-15 |
| 1215574603 | Miranda Denise Bowman | Counselor | 1300 Hoppe Blvd., Suite 5, Ada, OK 74820 | 2019-12-04 |
| 1326509654 | Patricia June Harjo | Case Manager/Care Coordinator | Nittak Himitta' Women's and Children's Recovery Center, 2024 Te Ata Drive, Ada, OK 74820 | 2019-03-28 |
| 1649737172 | Rylee Nikole Leblanc | Case Manager/Care Coordinator | 1119 S High School St, Ada, OK 74820 | 2019-02-20 |
| 1891251328 | David Kinback | Rehabilitation Counselor | 1400 Hoppe Blvd., Suite 3, Cn Recovery Resource Services, Ada, OK 74820 | 2019-02-20 |
| 1922571009 | Central Oklahoma Family Medical Center, Inc. | Pharmacy | 905 Colony Dr, Ada, OK 74820 | 2019-01-10 |
| 1063988673 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 905 Colony Drive Bldg, Ada, OK 74820 | 2018-10-22 |
| 1265907885 | Apex Surgery Center, LLC | Surgery | 2001 Cradduck Road, Ada, OK 74820 | 2018-10-10 |
| 1689150898 | Sabrina Simmons | Social Worker | 2516 Oakhurst Dr Apt E, Ada, OK 74820 | 2018-07-11 |
| 1700370467 | Brianna Leigh Youngwolfe | Nurse Practitioner | 2020 Arlington St Ste 6, Ada, OK 74820 | 2018-06-17 |
| Find all providers in zip 74820 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020867 | Mandi Withey, Ms, LLP, Pllc | Community/Behavioral Health | 4100 Picea Valley Ct Se, Ada, MI 49301-8587 | 2020-07-08 |
| 1265079552 | Victoria Jo Barnosky | Community/Behavioral Health | 1301 N Oak Ave Apt 207, Ada, OK 74820-1218 | 2019-12-05 |
| 1134523921 | Theea | Community/Behavioral Health | 9960 County Road 3500, Ada, OK 74820-3556 | 2014-10-22 |
| 1346669470 | Biofeedback Solutions, LLC | Community/Behavioral Health | 2102 N Broadway Ave, Ada, OK 74820-1048 | 2014-04-16 |
| 1780985952 | Chickasaw Nation | Community/Behavioral Health | 231 Seabrook Rd, Ada, OK 74820-1006 | 2010-11-04 |
| 1457558298 | Family Crisis Center, Inc | Community/Behavioral Health | 605 E 12th St, Ada, OK 74820-6605 | 2007-06-27 |
| 1124160122 | Ada Area Youth Shelter, Inc. | Community/Behavioral Health | 901 West 18th St., Ada, OK 74820 | 2007-02-13 |
| 1932749348 | Southern Oklahoma Treatment Serices, Inc. | Community/Behavioral Health | 1201 Arlington St Ste G, Ada, OK 74820-4072 | 2020-01-14 |
| 1649732116 | New Revelation Counseling Service LLC | Community/Behavioral Health | 975 Spaulding Ave Se Ste D, Ada, MI 49301-3776 | 2019-04-03 |
| 1023411907 | Addiction & Behavioral Health Center, Inc | Community/Behavioral Health | 124 S Broadway Ave, Suite 200, Ada, OK 74820-5820 | 2014-10-06 |
| Find all providers in ADA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.