Provider Demographics
NPI:1336979863
Name:MANDALA CLINICAL, LLC.
Entity type:Organization
Organization Name:MANDALA CLINICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-734-5223
Mailing Address - Street 1:236 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4149
Mailing Address - Country:US
Mailing Address - Phone:316-734-5223
Mailing Address - Fax:316-494-6348
Practice Address - Street 1:236 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4149
Practice Address - Country:US
Practice Address - Phone:316-734-5223
Practice Address - Fax:316-494-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty