NPIMap

Organization Active NPI

Mindful Therapy Group of Colorado, P.C.

  • Clinical Social Worker
  • Boulder, CO
National Provider Identifier
1053274076
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDFUL THERAPY GROUP OF COLORADO, P.C.
Practice address
1790 38TH St Ste 104
Boulder, CO 80301-2600
Phone
(720) 509-0795
Fax
(800) 377-1553
NPI assigned
Dec 5, 2025
Organization subpart
Yes
Parent organization
MINDFUL THERAPY GROUP OF COLORADO, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Pauly
Title
Payor Relationship Manager
Phone
(425) 640-7009

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

1790 38TH St Ste 104
Boulder, CO 80301-2600

Mailing address

6505 216TH St SW Ste 100
Mountlake Terrace, WA 98043-2089
Phone (425) 640-7009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240624004790 CO Part B Supplier - Clinic/Group Practice 3870036478 Receives reassigned benefits from 59 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westminster, CO; Fort Collins, CO; Boulder, CO; Greenwood Village, CO

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mindful Thpy GRP of Co PC10 organizations share this tax ID, including this one
Part of
Mindful Thpy GRP of Co PC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1764892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764892800000",
    "number": "1053274076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6505 216TH ST SW STE 100",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432089",
            "telephone_number": "425-640-7009",
            "fax_number": "425-678-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 38TH ST STE 104",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012600",
            "telephone_number": "720-509-0795",
            "fax_number": "800-377-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL THERAPY GROUP OF COLORADO, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINDFUL THERAPY GROUP OF COLORADO, P.C.",
        "enumeration_date": "2025-12-05",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A",
        "authorized_official_last_name": "PAULY",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PAYOR RELATIONSHIP MANAGER",
        "authorized_official_telephone_number": "425-640-7009"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.