MEDICARE: BOOST COUNSELING SERVICES, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1891338547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOOST COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2500 N TUCSON BLVD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2463
Country	:	US
Telephone Number	:	520-447-2433
Fax Number	:	520-492-1653

Provider Business Practice Location Address
First Line	:	2500 N TUCSON BLVD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2463
Country	:	US
Telephone Number	:	520-447-2433
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	LIANA JOY CONDELLO
Credential	:	MA, LIAC CCTP
Telephone Number	:	520-447-2433

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	06/04/2026

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