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MANDALA HOUSE LLC NPI 1659829760


NPI Information

NPI: 1659829760
Provider Name: MANDALA HOUSE, LLC

Doing Business As: MANDALA HOUSE

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
1190 E BROADWAY
LOUISVILLE, KY
ZIP 40204
Phone: (502) 627-0905
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MANDALA HOUSE, LLC is a clinical psychologist in Louisville, KY. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. MANDALA HOUSE, LLC NPI is 1659829760. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Mandala House.

The provider's business location address is:

1190 E BROADWAY
LOUISVILLE, KY
ZIP 40204-712
Phone: (502) 627-0905
Fax: (502) 208-1058

The provider's authorized official is Jacquelyn Gilles .
The authorized official title is Executive Director and has the following contact phone number (502) 309-2403.

The enumeration date for this NPI number is 9/18/2016 and was last updated on 6/20/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11041C0700XSocial WorkerClinicalNo
2106H00000XMarriage & Family TherapistNo
3103T00000XPsychologistNo
4103TC1900XPsychologistCounselingNo
52084P0800XPsychiatry & NeurologyPsychiatryNo
6103TC0700XPsychologistClinicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.