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Mandala House, LLC

Clinical Psychologist in Louisville, KY · enumerated 2016 · authorized official Jacks Gilles, Executive Director.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1659829760

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Registry record

Entity type Organization (Type 2)
Legal business name Mandala House, LLC
Other name <Unavail>
Practice address 633 Baxter Ave, Louisville, KY, 40204
Phone (502) 309-2408
Fax (502) 771-4283
Enumeration date Sep 18, 2016
Last updated in NPPES Jun 5, 2026

Taxonomy & classification

103T00000X Psychologist Behavioral Health & Social Service Providers Secondary
103TC0700X Clinical Psychologist Behavioral Health & Social Service Providers Primary
103TC1900X Counseling Psychologist Behavioral Health & Social Service Providers Secondary
1041C0700X Clinical Social Worker Behavioral Health & Social Service Providers Secondary
106H00000X Marriage & Family Therapist Behavioral Health & Social Service Providers Secondary
2084P0800X Psychiatry Physician Allopathic & Osteopathic Physicians Secondary

Authorized official

Name Jacks Gilles
Title Executive Director
Phone (502) 309-2403

Other identifiers

Identifier Type State Issuer
1659829760 Other KY NPI
7100489150 Medicaid KY -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.
What type of organization is Mandala House, LLC?
Mandala House, LLC is registered in NPPES as a Clinical Psychologist (its primary provider taxonomy).

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2026-06-05.