| The Jetty Counseling Center | |
|
1330 N Classen Blvd Ste 301 Oklahoma City OK 73106-6834 | |
| (405) 665-4385 | |
| (405) 665-6396 |
| Full Name | The Jetty Counseling Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1330 N Classen Blvd Ste 301, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Teresa Gale Rue-wallace (OWNER/CEO/PRESIDENT/EXEC. DIRECTOR) |
| 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 1330 N Classen Blvd Ste 301 Oklahoma City OK 73106-6834 Ph: (405) 665-4385 |
| NPI Number | 1073831350 |
|---|---|
| Provider Enumeration Date | 05/11/2010 |
| Last Update Date | 09/10/2021 |
| Certification Date | 09/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073831350 | NPI | - | NPPES |
| 100749080 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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