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Organization
PRO ACTIVE ADVANTAGE, LLC
Active
Organization
PRO ACTIVE ADVANTAGE, LLC
Active
Other names
Pro Active Behavioral Health, Proactive Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
LISA COLWELL (OFFICE MANAGER)
(208) 734-0407
Entity
Organization
Contact information
Practice address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 734-0407
(208) 734-3534
Mailing address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 734-0407
(208) 734-3534
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
ID
101YM0800X
Mental Health Counselor
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807373500
—
ID
Enumeration date
09/25/2006
Last updated
08/22/2023
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