PRO ACTIVE ADVANTAGE, LLC (NPI# 1073634713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073634713 |
| Entity Type | Organization |
| Organization Name | PRO ACTIVE ADVANTAGE, LLC |
| Other Organization Name | PRO ACTIVE BEHAVIORAL HEALTH |
| Practice Address |
2223 Overland Ave Burley ID 83318-2929 |
| Mailing Address |
215 University Dr Gooding ID 83330-6155 |
| Practice Telephone | 2088783423 |
| Practice Fax Number | 2088783424 |
| Mailing Telephone | 2089345880 |
| Mailing Fax Number | 2089345876 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2015-02-16 |
| Authorized Official Name | FRANK J. KNIGHT (CEO) |
| Authorized Official Telephone | 2089345880 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8073811 | 05 |
| Other Name | Type Code |
|---|---|
| Pro Active Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427170133 | Pro Active Advantage, LLC | Psychologist | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2007-04-04 |
| 1124148176 | Pro Active Advantage, LLC | Psychologist | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-03-30 |
| 1730200460 | Pro Active Advantage, LLC | Psychologist | 215 University Dr, Gooding, ID 83330-6155 | 2007-04-02 |
| 1225139298 | Pro Active Advantage, LLC | Counselor | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-09-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRO ACTIVE ADVANTAGE, LLC | 562 Shoup Ave W, Twin Falls, ID 83301-5029 |
| Street Address |
2223 OVERLAND AVE |
| City | BURLEY |
| State | ID |
| Zip Code | 83318-2929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124148176 | Pro Active Advantage, LLC | Psychologist | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-03-30 |
| 1023513777 | Nohemi Vasquez | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 2018-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902366834 | Pain & Spine Consultants | Clinic/Center | 1344 Hiland Avenue, Ste A, Burley, ID 83318 | 2019-03-25 |
| 1609335090 | Hurst Medical Pllc | Clinic/Center | 1700 Overland Ave Ste 1, Burley, ID 83318 | 2019-03-15 |
| 1831654243 | Mini-cassia Hearts 4 Seniors | In Home Supportive Care | 135 East 23rd Drive, Burley, ID 83318 | 2019-02-11 |
| 1841760493 | Burley Family Dental Pllc | Dentist | 2200 Parke Ave Ste 2, Burley, ID 83318 | 2018-11-27 |
| 1831634823 | Skye Fahnlander | Occupational Therapy Assistant | 2303 Parke Ave, Burley, ID 83318 | 2016-12-29 |
| 1285024497 | Albion Valley Health Clinic Inc. | Clinic/Center | 400 West 5th Street, Burley, ID 83318 | 2015-01-26 |
| 1124372370 | A Plus Solutions Center | Clinic/Center | 2311 Parke Ave. Unit 3, Suite 12, Burley, ID 83318 | 2012-11-08 |
| 1831442805 | A Plus Solutions Developmental Center LLC | Day Training, Developmentally Disabled Services | 2251 Overland Avenue, Suite Number 5, Burley, ID 83318 | 2012-10-16 |
| 1619258159 | Keleah Margrete Goldammer | Occupational Therapist | 2303 Parke Avenue, Burley, ID 83318 | 2011-08-29 |
| 1932490984 | Tamera Chatburn | Counselor | 531 East 5th St., Preferred Child and Family Services, Burley, ID 83318 | 2011-04-26 |
| Find all providers in zip 83318 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710503909 | Family Health Services Corporation | Counselor | 700 W 16th St, Burley, ID 83318-1710 | 2020-06-23 |
| 1922661404 | Family Health Services Corporation | Counselor | 1010 W 17th St, Burley, ID 83318-1746 | 2019-04-19 |
| 1952847857 | Andrea Gochnour | Counselor | 531 E 5th St, Burley, ID 83318-1469 | 2017-01-16 |
| 1518326263 | Garrett Condie | Counselor | 1321 Oakley Ave, Burley, ID 83318-1859 | 2016-02-22 |
| 1396137527 | Natalie Fern Bell | Counselor | 658 Overland Ave Ste 8, Burley, ID 83318-1300 | 2015-02-25 |
| 1295023711 | Susannah Marie West | Counselor | 2271 Overland Ave Ste 5, Burley, ID 83318-2957 | 2011-07-18 |
| 1285921643 | Duane Broderick | Counselor | 2311 Parke Ave., Ste. 8, Burley, ID 83350 | 2011-07-06 |
| 1841307188 | A Plus Solutions | Counselor | 2311 Park Ave, Unit 3 Suite 12, Burley, ID 83318-2170 | 2006-08-24 |
| 1477106995 | Nancy Manrique | Counselor | 531 E 5th St, Burley, ID 83318-1469 | 2019-07-23 |
| 1023513777 | Nohemi Vasquez | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 2018-03-26 |
| Find all providers in BURLEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.