NPIMap

Organization Active NPI

Mindful Therapy Group of Colorado, P.C.

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1124907407
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MINDFUL THERAPY GROUP OF COLORADO, P.C.
Practice address
3711 JFK Pkwy Ste 310
Fort Collins, CO 80525-2658
Phone
(970) 422-7260
Fax
(800) 377-1553
NPI assigned
Aug 29, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

3711 JFK Pkwy Ste 310
Fort Collins, CO 80525-2658

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

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1756425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756425600000",
    "number": "1124907407",
    "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": "3711 JFK PKWY STE 310",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252658",
            "telephone_number": "970-422-7260",
            "fax_number": "800-377-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL THERAPY GROUP OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-29",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "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",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.