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General NPI Number Information
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NPI Number | 1124907407
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Entity Type | Organization
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Legal Business Name | MINDFUL THERAPY GROUP OF COLORADO, P.C.
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 3711 JFK PKWY STE 310
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City | FORT COLLINS
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State | CO
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Zip | 80525-2658
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Country | US
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Telephone | 970-422-7260
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Fax | 800-377-1553
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Provider Business Mailing Address
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Address Line | 6505 216TH ST SW STE 100
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2089
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Country | US
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Telephone | 425-640-7009
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Fax | 425-678-6455
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Authorized Official
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Title or Position | PAYOR RELATIONSHIP MANAGER
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Name | NICOLE PAULY
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Credential | MHA
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Telephone | 425-640-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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