Pro Active Advantage, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PRO ACTIVE ADVANTAGE, LLC

Doing business as

Pro Active Behavioral Health

Practice address

1369 E 16TH St Ste 2
Burley, ID 83318-2008

Phone

(208) 878-3423

Fax

(208) 878-3424

NPI assigned

Apr 2, 2007

Last updated

Sep 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Frank J. Knight

Title

Ceo

Phone

(208) 934-5880

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pro Active Behavioral Health Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1073634713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 UNIVERSITY DR",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833306155",
            "telephone_number": "208-934-5880",
            "fax_number": "208-934-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1369 E 16TH ST STE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182008",
            "telephone_number": "208-878-3423",
            "fax_number": "208-878-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ACTIVE ADVANTAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-934-5880"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073811",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Active Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pro Active Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Burley, ID
• Providers in Burley, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.