Healthcare Provider Details

I. General information

NPI: 1992656565
Provider Name (Legal Business Name): A STATE OF MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SPRUCE ST STE 402
BOULDER CO
80302-4001
US

IV. Provider business mailing address

1111 SPRUCE ST STE 402
BOULDER CO
80302-4001
US

V. Phone/Fax

Practice location:
  • Phone: 303-416-6116
  • Fax:
Mailing address:
  • Phone: 303-416-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIAN ROYCE
Title or Position: MANAGING MEMBER & CLINICAL DIRECTOR
Credential: LPC
Phone: 303-416-6116