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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

GARY WALLER LCSW
NPI 1609546399
Social Worker - Clinical in Picayune, MS

Active since September 15, 2021PECOS Enrolled
417 W CANAL ST, PICAYUNE, MS 39466(601) 749-9477(769) 242-0030 Get Directions Write a Review

NPPES record last updated: June 22, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 12, 2026, Sep 15, 2021 (2 updates tracked since 2021).

About Gary Waller Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARY WALLER LCSW (NPI 1609546399) is an individual clinical provider in Picayune, Mississippi, licensed in Mississippi (C11878) and active in the NPI registry since September 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1609546399
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameGARY WALLERCredential: LCSW
Location Address417 W CANAL STPicayune, MS 39466-3951
Mailing Address417 W Canal StPicayune, MS 39466-3951 · (601) 749-9477 · Fax (601) 749-0605
Phone(601) 749-9477
Fax(769) 242-0030
Sole ProprietorYes
Medical School CMSOtherGraduated 2020
Enumeration DateSeptember 15, 2021
Last NPPES UpdateJune 22, 20262 updates tracked since enumeration
NPPES CertifiedJune 22, 2026
✔ NPI 1609546399 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MS · C11878
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
417 W CANAL ST, Picayune, MS 39466
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gary Waller Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5193293280
PECOS Enrollment IDI20260506004333
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39466 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $51.65 – $159.18
Typical copayment $0.00 (range $12.91 – $39.79)
Most-billed visit code NA
Established Patient
$64.96 typical visit price
range $16.15 – $129.61
Typical copayment $16.24 (range $4.03 – $32.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NEW LEAF MENTAL HEALTH & WELLNESS, PLLC
Clinic/Center (Multi-Specialty)
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 916-0665
KIMBERLY C SAULS LCSW
Social Worker (Clinical)
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 749-9477
DEVEN FEJKA CAMERON FNP-C, PMHNP-C
Nurse Practitioner (Family)
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 864-1336
JENNIFER MARIE LADNER-GRAHAM PHD
Psychologist
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 749-9477
ROOTED COUNSELING LLC
Marriage & Family Therapist
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 749-9477
MRS. PAULA T DUCHMANN LCSW
Social Worker (School)
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 749-9477
CATHERINE WALLER LCSW
Social Worker (Clinical)
417 W CANAL ST
PICAYUNE, MS 39466
Pearl River County (601) 749-9477

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gary Waller's NPI number?

The NPI number for Gary Waller is 1609546399. It was assigned to this individual provider in the NPPES registry on September 15, 2021.

Where is Gary Waller located?

Gary Waller practices at 417 W Canal St, Picayune, MS 39466. The listed phone number is (601) 749-9477.

What is Gary Waller's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Gary Waller enrolled in Medicare?

Yes. Gary Waller is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Gary Waller was last updated on June 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 56 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.