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

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: November 01, 2026.

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

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mandala House, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

17

Medicare enrollment records show 17 clinicians reassign Medicare billing to Mandala House, LLC, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 14 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 5

Nurse Practitioner5
Clinical Social Worker4
Mental Health Counselor4
Clinical Psychologist3
Marriage and Family Therapist1

Clinicians, nearest first (17)

Jacquelyn Gilles, PSY.D., LP
Clinical Psychologist
NPI 1124212972
633 BAXTER AVE
Louisville, KY 40204
(502) 309-2408
✔ PECOS✔ Accepts MedicareSame address
Jonathan Macdonald, LCSW, MFTA
Clinical Social Worker
NPI 1992522015
633 BAXTER AVE
Louisville, KY 40204
(502) 309-2408
✔ PECOS✔ Accepts MedicareSame address
Michael May, LCPC
Mental Health Counselor
NPI 1528491685
633 BAXTER AVE
Louisville, KY 40204
(502) 309-2408
✔ PECOS✔ Accepts MedicareSame address
David Schroerlucke, PSY.D.
Clinical Psychologist
NPI 1598071474
633 BAXTER AVE
Louisville, KY 40204
(502) 309-2408
✔ PECOS✔ Accepts MedicareSame address
Kennetha Williams, DNP, APRN, PMHNP-BC
Nurse Practitioner
NPI 1366787798
633 BAXTER AVE
Louisville, KY 40204
(502) 309-2408
✔ PECOS✔ Accepts MedicareSame address
Christopher Tyler
Clinical Social Worker
NPI 1497935324
1190 E BROADWAY
Louisville, KY 40204
(502) 627-0905
✔ PECOS✔ Accepts Medicare0.2 mi
Lucie Erlebachova, LMFT
Mental Health Counselor
NPI 1053548990
1100 E MARKET ST
Louisville, KY 40206
(502) 596-1000
✔ PECOS✔ Accepts Medicare0.5 mi
Barbara Keys, APRN, PMHNP
Nurse Practitioner
NPI 1871828004
200 E CHESTNUT ST
Louisville, KY 40202
(502) 588-0800
✔ PECOS1.5 mi
Sebastian Hamilton
Clinical Social Worker
NPI 1891436911
1025 S 2ND ST
Louisville, KY 40203
(502) 888-1362
✔ PECOS1.6 mi
Valerie Day, LMFT
Marriage and Family Therapist
NPI 1528494770
1620 ANDERSON ST
Louisville, KY 40210
(502) 224-5445
✔ PECOS✔ Accepts Medicare2.8 mi
Natalie Berry, PSY.D.
Clinical Psychologist
NPI 1578225728
3058 BARDSTOWN RD # 1285
Louisville, KY 40205
(502) 509-3609
✔ PECOS3.7 mi
Jordan Ford, APRN
Nurse Practitioner
NPI 1477146157
3430 NEWBURG RD STE 210
Louisville, KY 40218
(502) 454-8800
✔ PECOS4.4 mi
Jennifer Gordon, APRN
Nurse Practitioner
NPI 1235511072
4501 LOUISE UNDERWOOD WAY
Louisville, KY 40216
(502) 368-2340
✔ PECOS✔ Accepts Medicare5.8 mi
Ariel Brooks, LCSW
Clinical Social Worker
NPI 1558610626
200 HIGH RISE DR STE. 330
Louisville, KY 40213
(502) 589-8600
✔ PECOS✔ Accepts Medicare6.0 mi
Rachel Archer, LPCC
Mental Health Counselor
NPI 1053924845
250 ALPINE DR
Shelbyville, KY 40065
(502) 633-5683
✔ PECOS✔ Accepts Medicare29 mi
Kimberly Paul, M.ED., LPCC
Mental Health Counselor
NPI 1629542410
120 W STEPHEN FOSTER AVE STE 100
Bardstown, KY 40004
(502) 472-7293
✔ PECOS33 mi
Catherine Messinger, APRN
Nurse Practitioner
NPI 1811957350
789 EASTERN BYP STE 23
Richmond, KY 40475
(859) 544-8171
✔ PECOS✔ Accepts Medicare87 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

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.

Where is Mandala House, LLC located?

Mandala House, LLC is located at 633 Baxter Ave, Louisville, KY 40204. The listed phone number is (502) 309-2408.

What is Mandala House, LLC's specialty?

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

Is Mandala House, LLC enrolled in Medicare?

Yes. Mandala House, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mandala House, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 17 clinicians in 5 Medicare specialties reassign their Medicare billing to Mandala House, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (5), Clinical Social Worker (4) and Mental Health Counselor (4). Of these, 5 practice at this address and 14 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Mandala House, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield list Mandala House, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mandala House, LLC was last updated on June 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.