Healthcare Provider Details

I. General information

NPI: 1245094796
Provider Name (Legal Business Name): BLOOM COLLECTIVE HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 PERKINS ROWE STE E1607231
BATON ROUGE LA
70810-2067
US

IV. Provider business mailing address

10202 PERKINS ROWE STE E1607231
BATON ROUGE LA
70810-2067
US

V. Phone/Fax

Practice location:
  • Phone: 225-800-2989
  • Fax: 225-521-5153
Mailing address:
  • Phone: 225-800-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER POIRRIER
Title or Position: OWNER
Credential: LCSW
Phone: 225-800-2989