The Jetty Counseling Center | |
202 S Washita Ave Wynnewood OK 73098-7820 | |
(405) 665-4385 | |
(405) 665-6396 |
Full Name | The Jetty Counseling Center |
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Speciality | Community/behavioral Health |
Location | 202 S Washita Ave, Wynnewood, 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 |
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The Jetty Counseling Center 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 | The Jetty Counseling Center 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 |
NPI Number | 1982748067 |
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Provider Enumeration Date | 02/20/2007 |
Last Update Date | 09/08/2021 |
Certification Date | 09/08/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982748067 | NPI | - | NPPES |
100749080A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (Oklahoma) | Primary |