Active NPI
Keenyn Wald, LPC
- Mental Health Counselor
- Columbus, MS
National Provider Identifier
1710598255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1834
- Practice address
- 1011 Main St
Columbus, MS 39701-4751 - Phone
- (662) 327-7916
- NPI assigned
- Aug 10, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1834 | MS | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1834 | MS |
Addresses
Primary practice location
1011 Main St
Columbus, MS 39701-4751
Mailing address
302 N Jackson St
Starkville, MS 39759-2504
Phone (662) 327-7916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1834 | MS | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602720000000",
"number": "1710598255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 N JACKSON ST",
"city": "STARKVILLE",
"state": "MS",
"postal_code": "397592504",
"telephone_number": "662-327-7916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 MAIN ST",
"city": "COLUMBUS",
"state": "MS",
"postal_code": "397014751",
"telephone_number": "662-327-7916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALD",
"first_name": "KEENYN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-10",
"last_updated": "2020-10-15",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MS",
"license": "1834",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MS",
"license": "1834",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, MS
- Avery Villeret, MD
- Robert D Voller, MD
- Matthew Joel Wade, MD
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0495)
- Wal-Mart Stores, Inc. (Vision Center 30-0495)
- Chandra Waldrep
- Walgreen Co (Rite Aid)
- Walgreen Co (Walgreens #19986)
- Walgreen Co (Walgreens #02676)
- Walgreen Co (Walgreens Specialty Pharmacy #11599)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.