Organization
PRO ACTIVE ADVANTAGE, LLC
Active
Other names
Pro Active Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK J KNIGHT (CEO)
(208) 934-5880
Entity
Organization
Contact information
Practice address
1369 E 16TH ST STE 2, BURLEY, ID 83318-2008
(208) 878-3423
(208) 878-3424
Mailing address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 734-0407
(208) 734-3534
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8073698
—
ID
Enumeration date
03/30/2007
Last updated
09/15/2021
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