NPIMap

Organization Active NPI

Theraville Counseling Services, a LCSW Corporation

  • Clinical Social Worker
  • San Bernardino, CA
National Provider Identifier
1366084360
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
THERAVILLE COUNSELING SERVICES, A LCSW CORPORATION
Practice address
202 E Airport Dr Ste 265
San Bernardino, CA 92408-3444
Phone
(909) 939-5007
NPI assigned
Oct 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Crystal BurnsNPI 1962788620
Title
Owner/Clinician
Phone
(909) 767-3450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

202 E Airport Dr Ste 265
San Bernardino, CA 92408-3444

Mailing address

PO Box 559
Beaumont, CA 92223-0559
Phone (951) 386-9709

Other practice location 1

11801 Pierce St Ste 200
Riverside, CA 92505-4400
Phone (909) 939-5007

Other practice location 2

473 S Carnegie Dr Ste 200
San Bernardino, CA 92408-4201
Phone (909) 939-5007

Other names 1

  • Theraville Counseling Services, A Licensed Clinical Social Worker Corp Former legal business name

National Provider Directory

National Provider Directory

Locations

1325 E Cooley Dr
Ste 106
Colton, CA 92324
Phone (909) 492-0573

202 E Airport Dr
Ste 265
San Bernardino, CA 92408
Phone (909) 939-5007

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1366084360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 559",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922230559",
            "telephone_number": "951-386-9709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E AIRPORT DR STE 265",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083444",
            "telephone_number": "909-939-5007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11801 Pierce St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925054400",
            "country_code": "US",
            "telephone_number": "909-939-5007",
            "fax_number": "951-602-6508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "473 S Carnegie Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924084201",
            "country_code": "US",
            "telephone_number": "909-939-5007",
            "fax_number": "951-602-6508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THERAVILLE COUNSELING SERVICES, A LCSW CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "OWNER/CLINICIAN",
        "authorized_official_telephone_number": "909-767-3450"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theraville Counseling Services, A Licensed Clinical Social Worker Corp",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.