Provider Demographics
NPI:1578338745
Name:SARAVIA, CARLEY TOLMAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARLEY
Middle Name:TOLMAN
Last Name:SARAVIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CARLEY
Other - Middle Name:TOLMAN
Other - Last Name:MODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3204 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY VILLAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1713
Mailing Address - Country:US
Mailing Address - Phone:612-819-3007
Mailing Address - Fax:
Practice Address - Street 1:3204 36TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST ANTHONY VILLAGE
Practice Address - State:MN
Practice Address - Zip Code:55418-1713
Practice Address - Country:US
Practice Address - Phone:612-819-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health