PRO ACTIVE BEHAVIORAL HEALTH
NPI 1124148176
Psychologist - Rehabilitation in Burley, ID

Q: What is Pro Active Advantage, LLC's NPI number?

The NPI number for Pro Active Advantage, LLC is 1124148176. It was assigned to this organization in the NPPES registry on March 30, 2007. The provider is doing business as Pro Active Behavioral Health.

Q: What is Pro Active Advantage, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Rehabilitation, with taxonomy code 103TR0400X.

Active since March 30, 2007CLIA 13D2345764 · Waiver

1369 E 16TH ST STE 2, BURLEY, ID 83318(208) 878-3423(208) 878-3424 Get Directions Write a Review

NPPES record last updated: September 15, 2021. Verified against the NPPES registry weekly; last sync: September 20, 2026.

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About Pro Active Behavioral Health NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRO ACTIVE BEHAVIORAL HEALTH (NPI 1124148176) is a healthcare organization registered as a rehabilitation in Burley, Idaho and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through June 16, 2028 and lists Frank J Knight, Ceo, as its authorized official.

NPPES Registry Identity

NPI1124148176

Entity TypeOrganization

Primary Taxonomy103TR0400X

Legal Business NamePRO ACTIVE ADVANTAGE, LLC

Location Address1369 E 16TH ST STE 2Burley, ID 83318-2008

Mailing Address562 Shoup Ave WTwin Falls, ID 83301-5029 · (208) 734-0407 · Fax (208) 734-3534

Phone(208) 878-3423

Fax(208) 878-3424

Organization SubpartNo

Authorized OfficialFrank J KnightCeo · (208) 934-5880

Enumeration DateMarch 30, 2007

Last NPPES UpdateSeptember 15, 2021

NPPES CertifiedSeptember 15, 2021

✔ NPI 1124148176 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · RehabilitationBehavioral Health & Social Service Providers

Taxonomy Code103TR0400X

Definition

A psychologist who specializes in the study and application of psychological principles on behalf of persons who have disability due to injury or illness. Rehabilitation psychologists, often within teams, assess and treat cognitive, emotional, and functional difficulties, and help people to overcome barriers to participation in life activities. Rehabilitation psychologists are involved in practice, research, and advocacy, with the broad goal of fostering independence and opportunity for people with disabilities.

1369 E 16TH ST STE 2, Burley, ID 83318

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Other Names 1

Doing Business AsPro Active Behavioral Health

Other Identifiers 1

Medicaid8073698ID

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2345764

Proactive Behavioral Health · Twin Falls, ID

Active · expires Jun 16, 2028

CLIA Number13D2345764

Laboratory TypeSud Outpatient Treatment

Certificate Effective DateJune 17, 2026

Certificate Expiration DateJune 16, 2028

Laboratory DirectorErin M. Goodfellow

Laboratory Phone(208) 734-0407

Laboratory LocationProactive Behavioral Health562 Shoup Ave West, Twin Falls, ID 83301

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PRO ACTIVE ADVANTAGE, LLC

Counselor (Mental Health)

1369 E 16TH ST STE 2
BURLEY, ID 83318

Cassia County (208) 878-3423

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pro Active Advantage, LLC's NPI number?

The NPI number for Pro Active Advantage, LLC is 1124148176. It was assigned to this organization in the NPPES registry on March 30, 2007. The provider is doing business as Pro Active Behavioral Health.

Where is Pro Active Advantage, LLC located?

Pro Active Advantage, LLC is located at 1369 E 16th St Ste 2, Burley, ID 83318. The listed phone number is (208) 878-3423.

What is Pro Active Advantage, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Rehabilitation, with taxonomy code 103TR0400X.

Does Pro Active Advantage, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2345764) is associated with this NPI, valid through June 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pro Active Advantage, LLC was last updated on September 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.