# GARY WALLER LCSW LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447108550
- **Authorized official:** GARY DWIGHT WALLER LCSW (OWNER/ THERAPIST)
- **Authorized official phone:** (601) 749-9477

## Contact information

- **Practice address:** 1839 COOPER RD STE D, PICAYUNE, MS 39466-2836
- **Practice address phone:** (601) 749-9477
- **Practice address fax:** (601) 749-0605
- **Mailing address:** 1839 COOPER RD STE D, PICAYUNE, MS 39466-2836
- **Mailing address phone:** (601) 749-9477
- **Mailing address fax:** (601) 749-0605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2026
- **Last updated:** 03/17/2026