Individual
KEENYN WALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1011 MAIN ST, COLUMBUS, MS 39701-4751
(662) 327-7916
Mailing address
302 N JACKSON ST, STARKVILLE, MS 39759-2504
(662) 327-7916
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1834
MS
101YM0800X
Mental Health Counselor
Primary
1834
MS
Other
Enumeration date
08/10/2020
Last updated
10/15/2020
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