Gary Waller LCSW LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

GARY WALLER LCSW LLC

Practice address

1839 Cooper Rd Ste D
Picayune, MS 39466-2836

Phone

(601) 749-9477

Fax

(601) 749-0605

NPI assigned

Mar 17, 2026

Last updated

Mar 17, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gary Dwight Waller, LCSWNPI 1609546399

Title

Owner/ Therapist

Phone

(601) 749-9477

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary Waller, LCSW

  • Clinical Social Worker
  • Picayune, MS
  • NPI 1609546399
  Medicare reassignment NPD (past) Authorized official

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

{
    "created_epoch": "1773705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773705600000",
    "number": "1447108550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 COOPER RD STE D",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394662836",
            "telephone_number": "601-749-9477",
            "fax_number": "601-749-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 COOPER RD STE D",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394662836",
            "telephone_number": "601-749-9477",
            "fax_number": "601-749-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY WALLER LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-17",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DWIGHT",
        "authorized_official_title_or_position": "OWNER/ THERAPIST",
        "authorized_official_telephone_number": "601-749-9477",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Functional Therapy LLC
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• David Edward Futrell, D.D.S.
• Louis Charles Gambina, R.PH
• Charlene Faye Garrett
• Alice Gath
• Genesys Hope Gardens (personal care home ( A Taste of grace ))
• Johneen Gilich, OD
• Walter Edward Gipson IV, MD
• Ashley Glascoe, CPSS

• Clinical Social Worker in Picayune, MS
• Providers in Picayune, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.