MANDALA HOUSE, LLC
NPI 1659829760
Psychologist - Clinical in Louisville, KY

Q: What is Mandala House, LLC's NPI number?

The NPI number for Mandala House, LLC is 1659829760. It was assigned to this organization in the NPPES registry on September 18, 2016. The provider is doing business as Mandala House.

Q: What is Mandala House, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since September 18, 2016

633 BAXTER AVE, LOUISVILLE, KY 40204(502) 309-2408(502) 771-4283 Get Directions Write a Review

NPPES record last updated: June 5, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 5, 2026, Sep 30, 2024, Jun 20, 2019 and 5 more (8 updates tracked since 2016).

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About Mandala House, Llc NPPES

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

MANDALA HOUSE, LLC (NPI 1659829760), doing business as Mandala House, is a healthcare organization registered as a clinical in Louisville, Kentucky and active in the NPI registry since September 2016. The organization maintains 2 additional practice locations and lists Jacks Gilles, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1659829760

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameMANDALA HOUSE, LLC

Location Address633 BAXTER AVELouisville, KY 40204-1157

Mailing Address1169 Eastern Pkwy Ste 3353Louisville, KY 40217-1415 · (502) 309-2403 · Fax (502) 771-4283

Phone(502) 309-2408

Fax(502) 771-4283

Organization SubpartNo

Authorized OfficialJacks GillesExecutive Director · (502) 309-2403

Enumeration DateSeptember 18, 2016

Last NPPES UpdateJune 5, 20268 updates tracked since enumeration

NPPES CertifiedJune 5, 2026

✔ NPI 1659829760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

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.

Also ListedPsychologistTaxonomy 103T00000X

Also ListedPsychologist · CounselingTaxonomy 103TC1900X

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X

Also ListedMarriage & Family TherapistTaxonomy 106H00000X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

633 BAXTER AVE, Louisville, KY 40204

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Other Names 1

Doing Business AsMandala House

Secondary Practice Locations 2

Location 11190 E BroadwayLouisville, KY 40204-1712 · Phone (502) 627-0905 · Fax (502) 208-1058

Location 21169 Eastern Pkwy Ste 3353Louisville, KY 40217-1415 · Phone (502) 309-2408 · Fax (502) 771-4283

Other Identifiers 2

Other1659829760KY · Npi

Medicaid7100489150KY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

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

MRS. GABRIELLE TURNER ELZY

Psychologist (Counseling)