Provider Demographics
NPI:1306738711
Name:BAYOU BLOOM THERAPY, LLC
Entity type:Organization
Organization Name:BAYOU BLOOM THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED CLINICAL SOCIAL WOR
Authorized Official - Prefix:
Authorized Official - First Name:ATEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-287-6278
Mailing Address - Street 1:14150 GRAND SETTLEMENT BLVD APT 2307
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14150 GRAND SETTLEMENT BLVD APT 2307
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-4333
Practice Address - Country:US
Practice Address - Phone:225-287-6278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health