NPIMap

Organization Active NPI

Mindful Therapy Group of Colorado, PC

Doing business as Mindful Therapy Group

  • Clinical Social Worker
  • Fort Collins, CO
National Provider Identifier
1649092990
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDFUL THERAPY GROUP OF COLORADO, PC
Doing business as
Mindful Therapy Group
Practice address
3711 JFK Pkwy Ste 310
Fort Collins, CO 80525-2658
Phone
(970) 422-7260
Fax
(425) 678-6455
NPI assigned
Oct 28, 2024
Organization subpart
Yes
Parent organization
MINDFUL THERAPY GROUP OF COLORADO, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Nicole Pauly
Title
Provider Enrollment Manager
Phone
(425) 640-7009

Specialties & licenses 5

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

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) 678-6463

Other names 1

  • Mindful Therapy Group Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1649092990",
    "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": "425-678-6463",
            "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": "425-678-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL THERAPY GROUP OF COLORADO, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINDFUL THERAPY GROUP OF COLORADO, P.C.",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "PAULY",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT 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
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 28, 2024; 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.