Healthcare Provider Details

I. General information

NPI: 1033808852
Provider Name (Legal Business Name): BLOOM BEHAVIORAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 WOLF CIR
LAKE CHARLES LA
70605-2353
US

IV. Provider business mailing address

1734 WOLF CIR
LAKE CHARLES LA
70605-2353
US

V. Phone/Fax

Practice location:
  • Phone: 337-240-6038
  • Fax:
Mailing address:
  • Phone: 337-240-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHELBY SONNIER
Title or Position: CO-OWNER, BCBA, LBA
Credential: BCBA, LBA
Phone: 337-532-7826