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NPI Code Detail

MEDICARE: MANDALA THERAPEUTIC SERVICES

MEDICARE: MANDALA THERAPEUTIC SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker
3251B00000XCase Management Agency
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1053878413
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANDALA THERAPEUTIC SERVICES
Provider Business Mailing Address
First Line : 1201 SAINT CHRISTOPHER DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-388-2898
Fax Number :
Provider Business Practice Location Address
First Line : 1201 SAINT CHRISTOPHER DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7064
Country : US
Telephone Number : 606-388-2898
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JENNIFER SMITH
Credential : LCSW
Telephone Number : 606-388-2898
Provider Enumeration Date : 02/21/2019
Last Update Date : 03/06/2025

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Practice Location Address:
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1225502206 — CAITLIN WINKLER MSW, LCSW
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Directions to “MANDALA THERAPEUTIC SERVICES ” Practice Location

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