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General NPI Number Information
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NPI Number | 1760107387
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE MENTAL HEALTH & WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 605 AUSTIN AVE
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City | WACO
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State | TX
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Zip | 76701-2048
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Country | US
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Telephone | 254-900-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 605 AUSTIN AVE
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City | WACO
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State | TX
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Zip | 76701-2048
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Country | US
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Telephone | 254-900-7986
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. THEOPHLIUS WATSON III
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Credential | LCSW-S
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Telephone | 505-227-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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