| Bloom Behavioral Center, Llc | |
|
504 E College St Lake Charles LA 70605-1706 | |
| (337) 240-6038 | |
| Not Available |
| Full Name | Bloom Behavioral Center, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 504 E College St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Shelby Sonnier (CO-OWNER, BCBA, LBA) |
| Authorized Official Contact | 3375327826 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Behavioral Center, Llc 504 E College St Lake Charles LA 70605-1706 Ph: (337) 240-6038 | Bloom Behavioral Center, Llc 504 E College St Lake Charles LA 70605-1706 Ph: (337) 240-6038 |
| NPI Number | 1033808852 |
|---|---|
| Provider Enumeration Date | 05/08/2023 |
| Last Update Date | 07/11/2023 |
| Certification Date | 06/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033808852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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