Provider Demographics
NPI:1760107387
Name:ALLEGIANCE MENTAL HEALTH & WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:ALLEGIANCE MENTAL HEALTH & WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOPHLIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-227-4338
Mailing Address - Street 1:1061 HESSELRIDGE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-4401
Mailing Address - Country:US
Mailing Address - Phone:505-227-4338
Mailing Address - Fax:
Practice Address - Street 1:1061 HESSELRIDGE
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-4401
Practice Address - Country:US
Practice Address - Phone:505-227-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty