Jacks X. Gilles, PSY.D., LP
NPI 1124212972ActiveIndividual· Psychologist, Clinical· Louisville, KY
Psychologist, Clinical (PSY.D., LP) with Mandala House, LLC, practicing in Louisville, Kentucky. Enrolled in Medicare as practitioner - clinical psychologist.
Overview
| NPI | 1124212972 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PSY.D., LP |
| Sole proprietor | No |
| NPI issued | Sep 4, 2007 |
| Last updated in NPPES | Nov 19, 2024 |
| Certified by provider | Nov 19, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | 129842 | KY |
| Psychologist, Clinical | 103TC0700X | 1745 | KY |
| Psychologist, Clinical | 103TC0700X | 2012-12 | KY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (KY) |
|---|
Education and affiliations
| Graduation year | 2011 |
|---|---|
| Medicare specialty | Clinical Psychologist |
| Telehealth | Offers telehealth |
Medical group
- Mandala House, LLCLouisville, KY · 8 clinicians
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