Allegiance Mental Health & Wellness Services LLC
Organization Active NPI Clinical Social Worker · Waco, TX
NPI 1760107387 · NPPES record last updated Mar 21, 2025
Key facts
- NPI
- 1760107387
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- ALLEGIANCE MENTAL HEALTH & WELLNESS SERVICES LLC
- Practice address
- 605 Austin Ave
Waco, TX 76701-2048 - Phone
- (254) 900-7986
- NPI assigned
- Oct 6, 2022
- Organization subpart
- No
Authorized official
- Name
- Mr. Theophlius Watson III, LCSW-S
- Title
- Managing Member
- Phone
- (505) 227-4338
Practitioners 5
-
Theophlius Watson III, LCSW
-
Krista Leigh Watson, RN, BSN
-
Christine Roseann Idemudia, APRN-CNP
-
Stephanie Ann Matthews, LCSW
-
Wade Wheeler, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221215000024 | TX | Part B Supplier - Clinic/Group Practice | 2466821384 |
Receives reassigned benefits from 1 practitioner Practice locations: Waco, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Psychologist |
103T00000X | |||
| Clinical Psychologist |
103TC0700X | |||
| Social Worker |
104100000X | |||
| Clinical Social Worker |
1041C0700X | Yes | ||
| Marriage & Family Therapist |
106H00000X | |||
| Behavior Technician |
106S00000X | |||
| Registered Nurse |
163W00000X | |||
| Health & Wellness Coach |
171400000X | |||
| Psychiatry Physician |
2084P0800X | |||
| Nurse Practitioner |
363L00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | |||
| Student in an Organized Health Care Education/Training Program |
390200000X |
Addresses
Primary practice location
605 Austin Ave
Waco, TX 76701-2048
Mailing address
605 Austin Ave
Waco, TX 76701-2048
Phone (254) 900-7986
Other practice location 1
1061 Hesselridge
Hewitt, TX 76643-4401
Phone (505) 227-4338
Other names
- ALLEGIANCE COUNSELING
- ALLEGIANCE MENTAL HEALTH
- ALLEGIANCE WELLNESS
Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.