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Active NPI 1730200460 Organization (Entity Type 2)

Pro Active Advantage, Llc

Psychologist - Cognitive & Behavioral • Gooding, ID

About Pro Active Advantage, Llc NPI 1730200460 Summary

Pro Active Advantage, Llc is a verified healthcare organization specializing in Psychologist - Cognitive & Behavioral operating in Gooding, ID. Located at 215 UNIVERSITY DR, this facility provides patient care and medical services under National Provider Identifier (NPI) 1730200460.

Administrative operations and authorized compliance are overseen by Frank Knight (Ceo).

The facility is associated with 5 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

215 University Dr

Gooding, ID 833306155

Telephone 2089345880
Fax 2089345876

Authorized Official Information

Authorized Contact Name

Frank Knight

Title / Role

Ceo

Official Telephone

2089345880

Facility Classifications & Specialties

Psychologist - Cognitive & Behavioral Primary Taxonomy

NUCC Taxonomy Code: 103TB0200X

A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

5 Linked

Counselor - Mental Health

Gooding, ID

View Practitioner Profile →
Denise Jensen , LPC NPI 1346503877

Counselor - Professional

Gooding, ID

View Practitioner Profile →

Social Worker

Gooding, ID

View Practitioner Profile →

Social Worker

Gooding, ID

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

7 Historical Events
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Updated Business Mailing Address December 19, 2019

Registered at 562 SHOUP AVE W, TWIN FALLS, ID 833015029 (Tel: 2087340407)

NPI Profile Active February 16, 2015

NPI status registered as active in NPPES database

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Updated Practice Location February 16, 2015

Registered at 215 UNIVERSITY DR, GOODING, ID 833306155 (Tel: 2089345880)

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Updated Business Mailing Address February 16, 2015

Registered at 215 UNIVERSITY DR, GOODING, ID 833306155 (Tel: 2089345880)

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Organization / Clinic Name Updated February 16, 2015

Operating as PRO ACTIVE ADVANTAGE, LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 16, 2015

Psychologist

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Initial NPI Registration & Enumeration April 02, 2007

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

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NPI Organization Metadata

NPI Number: 1730200460
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: April 02, 2007
Last Update: September 15, 2021

Mailing Address

562 Shoup Ave W

Twin Falls, ID 833015029

Phone: 2087340407

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.