MEDICARE: BLOOM BEHAVIORAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033808852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BEHAVIORAL CENTER, LLC

Provider Business Mailing Address
First Line	:	1734 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-240-6038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-240-6038
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER, BCBA, LBA
Name	:	SHELBY SONNIER
Credential	:	BCBA, LBA
Telephone Number	:	337-532-7826

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	12/10/2025

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