Provider Demographics
NPI:1366084360
Name:THERAVILLE COUNSELING SERVICES, A LCSW CORPORATION
Entity type:Organization
Organization Name:THERAVILLE COUNSELING SERVICES, A LCSW CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-767-3450
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-0559
Mailing Address - Country:US
Mailing Address - Phone:951-386-9709
Mailing Address - Fax:
Practice Address - Street 1:202 E AIRPORT DR STE 265
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3444
Practice Address - Country:US
Practice Address - Phone:909-939-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty