| The Jetty Counseling Center | |
|
925 15th Ave Nw Ardmore OK 73401-1809 | |
| (580) 224-2830 | |
| (405) 665-6396 |
| Full Name | The Jetty Counseling Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 925 15th Ave Nw, Ardmore, Oklahoma |
| Authorized Official Name and Position | Teresa Gale Rue-wallace (OWNER/CEO/PRESIDENT/EXEC. DIRECTOR) |
| Authorized Official Contact | 4053068511 |
| 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 925 15th Ave Nw Ardmore OK 73401-1809 Ph: (580) 224-2830 |
| NPI Number | 1194860247 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 09/08/2021 |
| Certification Date | 09/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194860247 | NPI | - | NPPES |
| 100749080C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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