Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 FRANCIS ST
LONGMONT CO
80501-2576
US

IV. Provider business mailing address

645 MANHATTAN PL APT 105
BOULDER CO
80303-4074
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 TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002343
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0022773
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: