MEDICARE: BAHAM THERAPEUTIC SERVIES, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467386466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAHAM THERAPEUTIC SERVIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 84
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-0084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23592 BIG BRANCH DR
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-5587
Country	:	US
Telephone Number	:	985-474-5099
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDYN BAHAM
Credential	:	LCSW
Telephone Number	:	985-474-5099

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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