Provider Demographics
NPI:1932966439
Name:BOOST COUNSELING & NEUROFEEDBACK
Entity Type:Organization
Organization Name:BOOST COUNSELING & NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:951-216-3303
Mailing Address - Street 1:43832 CALLE COLINA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4903
Mailing Address - Country:US
Mailing Address - Phone:818-395-0584
Mailing Address - Fax:951-524-7575
Practice Address - Street 1:31045 TEMECULA PKWY STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3085
Practice Address - Country:US
Practice Address - Phone:951-216-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619559408Medicaid
CA1801527817Medicaid