PRO ACTIVE ADVANTAGE, LLC (NPI# 1730200460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730200460 |
| Entity Type | Organization |
| Organization Name | PRO ACTIVE ADVANTAGE, LLC |
| Other Organization Name | PRO ACTIVE BEHAVIORAL HEALTH |
| Practice Address |
215 University Dr Gooding ID 83330-6155 |
| Mailing Address |
562 Shoup Ave W Twin Falls ID 83301-5029 |
| Practice Telephone | 2089345880 |
| Practice Fax Number | 2089345876 |
| Mailing Telephone | 2087340407 |
| Mailing Fax Number | 2087343534 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2019-12-19 |
| 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 | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8067725 | 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 |
| 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 |
215 UNIVERSITY DR |
| City | GOODING |
| State | ID |
| Zip Code | 83330-6155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366562316 | Pro Active Advantage LLC | Counselor | 215 University Dr, Gooding, ID 83330-6155 | 2007-03-30 |
| 1669820346 | Felix Michael Arnold | Social Worker | 215 University Dr, Gooding, ID 83330-6155 | 2016-06-02 |
| 1861873853 | Chelsey Winkle | Social Worker | 215 University Dr, Gooding, ID 83330-6155 | 2015-06-15 |
| 1407253669 | Pro Active Advantage LLC | Community/Behavioral Health | 215 University Dr, Gooding, ID 83330-6155 | 2014-12-03 |
| 1316344625 | Joshua D Cooke | Counselor | 215 University Dr, Gooding, ID 83330-6155 | 2014-12-02 |
| 1649525049 | Brandon Douglas Knight | Social Worker | 215 University Dr, Gooding, ID 83330-6155 | 2012-07-23 |
| 1023371457 | Heather Kaye Birkhimer | Counselor | 215 University Dr, Gooding, ID 83330-6155 | 2012-06-20 |
| 1346503877 | Denise Marie Jensen | Counselor | 215 University Dr, Gooding, ID 83330-6155 | 2012-06-19 |
| 1093027377 | Stephanie Jan Bowles | Counselor | 215 University Dr, Gooding, ID 83330-6155 | 2010-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346648227 | Erin Orloff | Speech-Language Pathologist | 202 14th St Ave E, Gooding, ID 83330 | 2014-12-09 |
| 1518377019 | North Canyon Medical Center, Inc. | Clinic/Center | 267 N. Canyon Drive, Gooding, ID 83330 | 2014-05-06 |
| 1083959332 | Lydia Jo Missal | Counselor | 1832 E. 1750 S., Gooding, ID 83330 | 2012-11-27 |
| 1013240910 | Marcella Louise Heil | Speech-Language Pathologist | 1735 South 1800 East, Gooding, ID 83330 | 2009-09-09 |
| 1861561094 | Thomas Ernest Pryor | Family Medicine | 121 5th Ave West, Gooding, ID 83330 | 2006-11-06 |
| 1942212600 | Marcy Lin Morrow | Physician Assistant | 134 4th Ave W, Gooding Family Physicians, Gooding, ID 83330 | 2006-08-12 |
| 1174535835 | Ian B Kunz | Physician Assistant | 267 N Canyon Drive, Gooding, ID 83330 | 2006-08-12 |
| 1326002650 | Associates In Family Practice Pa | Family Medicine | 425 Idaho St, Gooding, ID 83330 | 2006-04-13 |
| 1497719728 | Mark D Spencer | Family Medicine | 425 Idaho Street, Gooding, ID 83330 | 2006-04-13 |
| 1871115717 | Megan George | Counselor | 1832 E 1750 S, Gooding, ID 83330 | 2020-05-14 |
| Find all providers in zip 83330 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861039943 | Corinne Patricia Bottrell | Psychologist | 547 S Fitness Pl Ste 110, Eagle, ID 83616-6552 | 2019-12-07 |
| 1639658248 | Luis Rodriguez | Psychologist | 1400 Eas Terry Dr Bldg 63 Garrison Hall 5th Floor, Pocatello, ID 83209-0001 | 2018-08-14 |
| 1700220209 | Colton D. Miller | Psychologist | 231 Student Health & Counseling Bldg, Rexburg, ID 83460-2020 | 2013-04-26 |
| 1023287612 | Steven Randall Lawyer | Psychologist | Idaho State University, Department of Psychology, Stop 8112, Pocatello, ID 83209-8112 | 2008-02-27 |
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.