Healthcare Provider Details

I. General information

NPI: 1306738711
Provider Name (Legal Business Name): BAYOU BLOOM THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 GRAND SETTLEMENT BLVD APT 2307
BATON ROUGE LA
70818-4333
US

IV. Provider business mailing address

14150 GRAND SETTLEMENT BLVD APT 2307
BATON ROUGE LA
70818-4333
US

V. Phone/Fax

Practice location:
  • Phone: 225-287-6278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ATEISHA CAGE
Title or Position: OWNER/ LICENSED CLINICAL SOCIAL WOR
Credential: LCSW
Phone: 225-287-6278