MEDICARE: THERAVILLE PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1326973983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAVILLE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 559
Second Line	:
City	:	BEAUMONT
State	:	CA
Zip	:	92223-0559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST
Second Line	:	STE 216
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	909-767-3450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRYSTAL BURNS
Credential	:	LCSW
Telephone Number	:	909-767-3450

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “THERAVILLE PLLC ” Practice Location

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