Active NPI
Pro Active Advantage, LLC
- Cognitive & Behavioral Psychologist
- Gooding, ID
National Provider Identifier
1730200460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- Legal business name
- PRO ACTIVE ADVANTAGE, LLC
- Practice address
- 215 University Dr
Gooding, ID 83330-6155 - Phone
- (208) 934-5880
- Fax
- (208) 934-5876
- NPI assigned
- Apr 2, 2007
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | Primary |
Addresses
Primary practice location
215 University Dr
Gooding, ID 83330-6155
Mailing address
562 Shoup Ave W
Twin Falls, ID 83301-5029
Phone (208) 734-0407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8067725 | Medicaid | ID |
Other names 1
- Pro Active Behavioral Health
National Provider Directory
National Provider Directory- Tax ID family
- Pro Active Advantage LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rehabilitation Psychologist
- Burley, ID
- NPI 1124148176
-
- Community/Behavioral Health Agency
- Gooding, ID
- NPI 1407253669
-
- Rehabilitation Psychologist
- Twin Falls, ID
- NPI 1427170133
NPI Registry JSON
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": "1730200460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "562 SHOUP AVE W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015029",
"telephone_number": "208-734-0407",
"fax_number": "208-734-3534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"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"
}
],
"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": "103TB0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8067725",
"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"
}
]
}Other providers in Gooding, ID
Sources for this page
- 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.