Healthcare Provider Details

I. General information

NPI: 1063981298
Provider Name (Legal Business Name): MELISSA GRIVY LPCC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 GOSS ST APT J
BOULDER CO
80302-8106
US

IV. Provider business mailing address

1937 GOSS ST APT J
BOULDER CO
80302-8106
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-0096
  • Fax:
Mailing address:
  • Phone: 720-432-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0020498
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002343
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: