Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jacks X Gilles, PSYD, LP

Individual provider Clinical Psychologist · NPI 1124212972

Dr. Jacks X Gilles, PSYD, LP is a Clinical Psychologist in Louisville, Kentucky. Qualified in 2011, 15 years ago. Practices with Mandala House, LLC, an 8-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Kentucky.

Years since qualifying
15
Licensed in
KY
In the registry since
2007
Specialties on file
3
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

633 Baxter Ave
Louisville, KY 40204-1157
Phone: (502) 309-2408
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1190 E Broadway, Louisville, KY 40204-1712 — (502) 627-0905

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 129842 (KY)
Clinical Psychologist Taxonomy 103TC0700X · Licence 1745 (KY)
Clinical Psychologist Taxonomy 103TC0700X · Licence 2012-12 (KY)

Record details

NPI number1124212972
Entity typeIndividual (Type 1)
GenderNot disclosed
Credentials PSYD , LP
Sole proprietorNo
NPI enumeratedSeptember 4, 2007
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Mandala House, Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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