Provider Demographics
NPI:1891338547
Name:BOOST COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:BOOST COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CONDELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LISAC, CCTP
Authorized Official - Phone:520-548-8974
Mailing Address - Street 1:PO BOX 36144
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6144
Mailing Address - Country:US
Mailing Address - Phone:520-548-8974
Mailing Address - Fax:
Practice Address - Street 1:3045 N 1ST AVE STE A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2560
Practice Address - Country:US
Practice Address - Phone:520-548-8974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty