Healthcare Provider Details

I. General information

NPI: 1235054123
Provider Name (Legal Business Name): MINDFUL THERAPY GROUP OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD FL 1 ROOM 114 AND ROOM 116
COLORADO SPRINGS CO
80920-3932
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 970-998-2011
  • Fax: 303-484-6996
Mailing address:
  • Phone: 425-640-7009
  • Fax: 425-678-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: MHA
Phone: 425-640-7009