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General NPI Number Information
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NPI Number | 1073831350
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Entity Type | Organization
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Legal Business Name | JIM WALLACE & ASSOCIATES, INC
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 1320 E 9TH ST STE 4
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City | EDMOND
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State | OK
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Zip | 73034-5773
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Country | US
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Telephone | 405-665-4385
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Fax | 405-665-6396
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Provider Business Mailing Address
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Address Line | 202 S WASHITA AVE
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City | WYNNEWOOD
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State | OK
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Zip | 73098-7820
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Country | US
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Telephone | 405-665-4385
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Fax | 405-665-6396
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Authorized Official
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Title or Position | OWNER/CEO/PRESIDENT/EXEC. DIRECTOR
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Name | MS. TERESA GALE RUE-WALLACE
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Credential | MASTERS SCIENCE
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Telephone | 405-665-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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