Allyssa Denise Waterman, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2019044872 Issued in MO

Practice address

3955 S Farm Road 223
Rogersville, MO 65742-8807

Phone

(417) 812-4440

Fax

(417) 208-5880

NPI assigned

Jan 27, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ally Waterman Other name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131
  Medicare reassignment NPD
• Citizens Memorial Healthcare

  • Rural Health Clinic/Center
  • Willard, MO
  • NPI 1568127397
  NPD
• Synergy Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Rogersville, MO
  • NPI 1326414350
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1407509896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21753 LEONARD LN",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655837846",
            "telephone_number": "417-872-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 S FARM ROAD 223",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657428807",
            "telephone_number": "417-812-4440",
            "fax_number": "417-208-5880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 E Republic Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658046588",
            "country_code": "US",
            "telephone_number": "417-351-4282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "ALLYSSA",
        "middle_name": "DENISE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-27",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2019044872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALLY",
            "last_name": "WATERMAN",
            "credential": "LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Russell Thurman, PTA
• Jill Tillman, MPT
• Sarah Townlian
• Michele Tyson, ANP-BC
• Kathryn Lynn Vanhooser, LPC
• Charles Kevin Watt, DO
• Audrey Marie Williams, DO
• Willow Health Care Inc
• George F Wong III, MD

• Professional Counselor in Rogersville, MO
• Providers in Rogersville, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.