Healthcare Provider Details

I. General information

NPI: 1326973983
Provider Name (Legal Business Name): THERAVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 216
PHOENIX AZ
85032
US

IV. Provider business mailing address

PO BOX 559
BEAUMONT CA
92223-0559
US

V. Phone/Fax

Practice location:
  • Phone: 909-767-3450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BURNS
Title or Position: OWNER
Credential: LCSW
Phone: 909-767-3450