| The Jetty Counseling Center | |
|
119 N. Broadway Suite 7 Ada OK 74820 | |
| (580) 310-0860 | |
| (405) 665-6396 |
| Full Name | The Jetty Counseling Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 119 N. Broadway, Ada, Oklahoma |
| Authorized Official Name and Position | James E Wallace (CEO FINANCIAL ADMINISTRATOR) |
| Authorized Official Contact | 4056654385 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Jetty Counseling Center 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 | The Jetty Counseling Center 119 N. Broadway Suite 7 Ada OK 74820 Ph: (580) 310-0860 |
| NPI Number | 1164557492 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164557492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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