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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