<Unavail>

LBN: Mandala House, Llc
<Unavail> is an health care organization with primary practice located at 633 Baxter Ave , Louisville KY 40204-1157. The organization recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Marriage & Family Therapist, Allopathic & Osteopathic Physicians / Psychiatry. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty. Mandala House, Llc can be contacted via phone (502) 309-2408, or through Gilles, Jacks via phone (502) 309-2403.

Contact Information

Primary practice address
633 Baxter Ave Louisville KY 40204-1157
Phone: (502) 309-2408
Fax: (502) 771-4283
Website:
Map and Directions
Authorized official contact:
Name: Gilles, Jacks PSY.D., LP
Phone: (502) 309-2403

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Behavioral Health & Social Service Providers / Counseling 103TC1900X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X

Profile Details

NPI number 1659829760
LBN Legal business name Mandala House, Llc
DBA Doing business as <Unavail>
Authorized official Gilles, Jacks PSY.D., LP
Entity Organization
Organization subpart 1 No
Enumeration date Sep 18th, 2016
Last updated Jun 5th, 2026 - about 4 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1659829760 NPPES
Kentucky Other 1659829760 NPI
Kentucky MEDICAID 7100489150 NPI

Popular Providers