| Mandala Therapeutic Services | |
|
314 Ferry St Russell KY 41169-1371 | |
| (606) 203-2820 | |
| Not Available |
| Full Name | Mandala Therapeutic Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 314 Ferry St, Russell, Kentucky |
| Authorized Official Name and Position | Jennifer Smith (OWNER) |
| Authorized Official Contact | 6063882898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandala Therapeutic Services 314 Ferry St Russell KY 41169-1371 Ph: (606) 388-2898 | Mandala Therapeutic Services 314 Ferry St Russell KY 41169-1371 Ph: (606) 203-2820 |
| NPI Number | 1053878413 |
|---|---|
| Provider Enumeration Date | 02/21/2019 |
| Last Update Date | 04/22/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 3173965241 |
|---|---|
| Medicare Enrollment ID | O20240522000415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053878413 | NPI | - | NPPES |
| Provider Name | Caitlin P Winkler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225502206 PECOS PAC ID: 7214274232 Enrollment ID: I20190130000159 |
| Provider Name | Jennifer R Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881115061 PECOS PAC ID: 7214263557 Enrollment ID: I20190724003952 |
| Provider Name | Gerri Lin Hobbs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215623145 PECOS PAC ID: 8426592510 Enrollment ID: I20240701000587 |
| Provider Name | Pauletta Bates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235807108 PECOS PAC ID: 1759821622 Enrollment ID: I20240905003637 |
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