Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gary Waller, LCSW

Individual provider Clinical Social Worker · NPI 1609546399

Gary Waller, LCSW is a Clinical Social Worker in Picayune, Mississippi. Qualified in 2020, 6 years ago. Practices as a sole proprietor. Licensed in Mississippi.

Years since qualifying
6
Licensed in
MS
In the registry since
2021
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

417 W Canal St
Picayune, MS 39466-3951
Phone: (601) 749-9477
Fax: (769) 242-0030
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence C11878 (MS)

Record details

NPI number1609546399
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedSeptember 15, 2021
Last updated in NPPESJune 22, 2026
Certification dateJune 22, 2026
Mailing address417 W Canal St, Picayune, MS 39466-3951

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated

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