NPIMap

Organization Active NPI

Mandala Therapeutic Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ashland, KY
National Provider Identifier
1053878413
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MANDALA THERAPEUTIC SERVICES
Practice address
1201 Saint Christopher Dr
Ashland, KY 41101-7064
Phone
(606) 388-2898
NPI assigned
Feb 21, 2019
Last updated
Mar 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Smith, LCSWNPI 1881115061
Title
Owner
Phone
(606) 388-2898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

1201 Saint Christopher Dr
Ashland, KY 41101-7064

Mailing address

1201 Saint Christopher Dr
Ashland, KY 41101-7064
Phone (606) 388-2898

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240522000415 KY Part B Supplier - Clinic/Group Practice 3173965241 Receives reassigned benefits from 5 practitioners
Practice locations: Ashland, KY

National Provider Directory

National Provider Directory

Locations

314 Ferry St
Russell, KY 41169
Phone (606) 388-2898

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1053878413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SAINT CHRISTOPHER DR",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411017064",
            "telephone_number": "606-388-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SAINT CHRISTOPHER DR",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411017064",
            "telephone_number": "606-388-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDALA THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-21",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-388-2898",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.