Proactive Behavior Therapy

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Legal business name

PROACTIVE BEHAVIOR THERAPY

Practice address

12573 Chillicothe Road
Chesterland, OH 44026

Phone

(440) 313-8636

Fax

(855) 960-0149

NPI assigned

Jul 14, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Leah Christine Gongola, PH.D., BCBA-D, COBANPI 1851605901

Title

Founder and Ceo

Phone

(440) 313-8636

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Proactive Behavior Services Doing business as

Tax ID family

Proactive Behavior Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Proactive Behavior Therapy, LLC

  • Community/Behavioral Health Agency
  • Chesterland, OH
  • NPI 1184275117
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leah Christine Gongola, PH.D., BCBA-D

  • Behavior Analyst
  • Huntsburg, OH
  • NPI 1851605901
  NPD Authorized official

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1912686197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12573 CHILLICOTHE ROAD",
            "city": "CHESTERLAND",
            "state": "OH",
            "postal_code": "44026",
            "telephone_number": "440-313-8636",
            "fax_number": "855-960-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12573 CHILLICOTHE ROAD",
            "city": "CHESTERLAND",
            "state": "OH",
            "postal_code": "44026",
            "telephone_number": "440-313-8636",
            "fax_number": "855-960-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE BEHAVIOR THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "GONGOLA",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "FOUNDER AND CEO",
        "authorized_official_telephone_number": "440-313-8636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., BCBA-D, COBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0477305",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive Behavior Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph S Parisi, OD
• Kevin Peterca, LISW
• Thomas Phelps, MD
• McInally Piette, N.P.
• Pro-Activities LLC
• Proactive Behavior Therapy, LLC
• Ann Marie Profeta
• Andleeb Qureshi
• Mark Raicevich
• Raise Geauga, Inc.

• Behavior Technician in Chesterland, OH
• Providers in Chesterland, OH by specialty
• Behavior Technician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; 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.