PRO ACTIVE ADVANTAGE, LLC (NPI# 1427170133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427170133 |
| Entity Type | Organization |
| Organization Name | PRO ACTIVE ADVANTAGE, LLC |
| Other Organization Name | PRO ACTIVE BEHAVIORAL HEALTH |
| Practice Address |
264 Main Ave S Twin Falls ID 83301-6232 |
| Mailing Address |
215 University Dr Gooding ID 83330-6155 |
| Practice Telephone | 2087340407 |
| Practice Fax Number | 2087343534 |
| Mailing Telephone | 2089345880 |
| Mailing Fax Number | 2089345876 |
| Enumeration Date | 2007-04-04 |
| 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 | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8062720 | 05 |
| Other Name | Type Code |
|---|---|
| Pro Active Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1073634713 | Pro Active Advantage, LLC | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 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 |
264 MAIN AVE S |
| City | TWIN FALLS |
| State | ID |
| Zip Code | 83301-6232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841852621 | Lisa Marlene Bayes | Counselor | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2019-07-02 |
| 1902396153 | Davina Gjennestad | Counselor | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2018-05-14 |
| 1629465174 | Tammy L Felps | Counselor | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2015-04-22 |
| 1336536937 | Steven Van Parker | Counselor | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2015-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023645918 | Matthew Anderson | Pharmacist | Dick's Pharmacy, 526 K Shoup Ave W, Twin Falls, ID 83301 | 2020-03-23 |
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1972073377 | Wood River Acupuncture | Acupuncturist | 1625 Addison Ave East, Twin Falls, ID 83301 | 2018-11-28 |
| 1235629874 | Lonnie Paul | Counselor | 1092 Eastland Dr N Ste A, Twin Falls, ID 83301 | 2018-05-17 |
| 1679060966 | Christina Jirapha Thongdee | Social Worker | 625 Poleline Road West, Suite 2a, Twin Falls, ID 83301 | 2018-04-23 |
| 1437658499 | Tyrel Kevin Ward | Chiropractor | 2167 Village Park Ave., Suite 100, Twin Falls, ID 83301 | 2018-02-06 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1578005195 | Matthew Carter | Physical Therapist | 1053 Eastland Drive, Twin Falls, ID 83301 | 2016-11-14 |
| 1790227783 | Murvat Usmanova | Nurse Practitioner | 775 Pole Line Road W, Suite 203, Twin Falls, ID 83301 | 2016-11-08 |
| 1265894687 | Shawna Fultz | Social Worker | 1201 Fall Ave East Suite C, Twin Falls, ID 83301 | 2016-03-24 |
| Find all providers in zip 83301 | ||||
| Taxonomy Code | 103TR0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467702829 | Rick N. Ho Chee | Psychologist | 2466 Addison Ave. East, Twin Falls, ID 83301 | 2012-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376160820 | Mind Matters LLC | Psychologist | 8382 N Wayne Dr Ste 103b, Hayden, ID 83835-6028 | 2020-07-01 |
| 1003392598 | Joshua Welz | Psychologist | 3211 N Guinness Ln Apt 201, Post Falls, ID 83854 | 2018-07-17 |
| 1780061507 | Frank Howe | Psychologist | 167 North 4th East, Downey, ID 83234-0282 | 2015-04-30 |
| 1124454509 | Carlos Williams | Psychologist | 4696 W Overland Rd Ste 252, Boise, ID 83705-2877 | 2013-09-18 |
| 1528400793 | Marilyn Standfield | Psychologist | 1202 E 25th St, Idaho Falls, ID 83404-7072 | 2013-07-29 |
| 1932454642 | Adolpho Enterprise LLC. | Psychologist | 2847 Hidden Hutch, Ammon, ID 83401-6036 | 2012-07-18 |
| 1174833966 | Kimberly Sue Kelly | Psychologist | 630 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2010-10-14 |
| 1821207580 | Firm Fouindations LLC | Psychologist | 2496 Mesa St, Idaho Falls, ID 83401-3369 | 2007-05-21 |
| 1124148176 | Pro Active Advantage, LLC | Psychologist | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-03-30 |
| 1699099606 | Matthew Allen Bishop | Psychologist | 1740 E 17th St, Suite C, Idaho Falls, ID 83404-6375 | 2010-03-19 |
| Find all providers with the same taxonomy | ||||
| City | TWIN FALLS |
| Zip Code | 83301 |
Please comment or provide details below to improve the information on PRO ACTIVE ADVANTAGE, LLC.
| 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.