MANDALA HOUSE LLC NPI 1659829760

NPI Information

  • NPI: 1659829760
  • Provider Name: MANDALA HOUSE, LLC
  • Classification: Psychologist - 103TC0700X
  • Specialization: Clinical
  • Entity Type: Organization
  • Doing Business As: MANDALA HOUSE
  • Address: 633 BAXTER AVE
    LOUISVILLE, KY
    ZIP 40204
  • Phone: (502) 309-2408

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NPI Details

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:

633 BAXTER AVE
LOUISVILLE, KY
ZIP 40204-157
Phone: (502) 309-2408
Fax: (502) 771-4283

The provider's authorized official is Jacks 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 9/30/2024.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103T00000XPsychologistNo
2103TC0700XPsychologistClinicalYes
3103TC1900XPsychologistCounselingNo
41041C0700XSocial WorkerClinicalNo
5106H00000XMarriage & Family TherapistNo
62084P0800XPsychiatry & NeurologyPsychiatryNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11659829760OTHERKENTUCKYNPI
27100489150MEDICAIDKENTUCKY

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: 11/21/2025

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