| Pro Active Behavioral Health | |
|
1369 E 16th St Ste 2 Burley ID 83318-2008 | |
| (208) 878-3423 | |
| (208) 878-3424 |
| Full Name | Pro Active Behavioral Health |
|---|---|
| Speciality | Psychologist - Rehabilitation |
| Location | 1369 E 16th St Ste 2, Burley, Idaho |
| Authorized Official Name and Position | Frank J Knight (CEO) |
| Authorized Official Contact | 2089345880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro Active Behavioral Health 562 Shoup Ave W Twin Falls ID 83301-5029 Ph: (208) 734-0407 | Pro Active Behavioral Health 1369 E 16th St Ste 2 Burley ID 83318-2008 Ph: (208) 878-3423 |
| NPI Number | 1124148176 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 09/15/2021 |
| Certification Date | 09/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124148176 | NPI | - | NPPES |
| 8073698 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Primary |
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