Healthcare Provider Details

I. General information

NPI: 1053274076
Provider Name (Legal Business Name): MINDFUL THERAPY GROUP OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 38TH ST STE 104
BOULDER CO
80301-2600
US

IV. Provider business mailing address

6505 216TH ST SW STE 100
MOUNTLAKE TERRACE WA
98043-2089
US

V. Phone/Fax

Practice location:
  • Phone: 720-509-0795
  • Fax: 800-377-1553
Mailing address:
  • Phone: 425-640-7009
  • Fax: 425-678-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE PAULY
Title or Position: PAYOR RELATIONSHIP MANAGER
Credential:
Phone: 425-640-7009