MEDICARE: MELISSA GRIVY LPC, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0002343	CO
2	101YP2500X	Professional Counselor	LPC.0022773	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063981298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GRIVY LPC, LAC

Provider Business Mailing Address
First Line	:	645 MANHATTAN PL APT 105
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-4074
Country	:	US
Telephone Number	:	720-432-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 FRANCIS ST
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	720-432-0096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	05/07/2026

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