Organization
PRO ACTIVE ADVANTAGE, LLC
Active
Other names
Pro Active Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
PAT MARECKI B.S. (HUMAN RESOURCES)
(208) 772-4935
Entity
Organization
Contact information
Practice address
215 UNIVERSITY DR, GOODING, ID 83330-6155
(208) 934-5880
(208) 934-5876
Mailing address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 734-0407
(208) 734-3534
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC-5654
ID
Other
Enumeration date
12/03/2014
Last updated
09/15/2021
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