Healthcare Provider Details

I. General information

NPI: 1780258004
Provider Name (Legal Business Name): CARAVEL COUNSELING AND DIAGNOSTICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COMMERCE DR STE 260
WOODBURY MN
55125-9243
US

IV. Provider business mailing address

1575 ALLOUEZ AVE
GREEN BAY WI
54311-5639
US

V. Phone/Fax

Practice location:
  • Phone: 920-857-9041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MILLER
Title or Position: CEO
Credential:
Phone: 920-857-9041