Provider Demographics
NPI:1063981298
Name:GRIVY, MELISSA (LPCC, LAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRIVY
Suffix:
Gender:
Credentials:LPCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 GOSS ST APT J
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-8106
Mailing Address - Country:US
Mailing Address - Phone:720-432-0096
Mailing Address - Fax:
Practice Address - Street 1:1937 GOSS ST APT J
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-8106
Practice Address - Country:US
Practice Address - Phone:720-432-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002343101YA0400X
COLPCC.0020498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)