| Bayou Roots Therapy Collective Llc | |
|
117 Heymann Blvd Ste 14 Lafayette LA 70503-2397 | |
| (337) 385-0405 | |
| (337) 385-0405 |
| Full Name | Bayou Roots Therapy Collective Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 117 Heymann Blvd Ste 14, Lafayette, Louisiana |
| Authorized Official Name and Position | Leslie Herhold (OWNER) |
| Authorized Official Contact | 3372780786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayou Roots Therapy Collective Llc Po Box 55 Gulf Shores AL 36547-0055 Ph: (337) 278-0786 | Bayou Roots Therapy Collective Llc 117 Heymann Blvd Ste 14 Lafayette LA 70503-2397 Ph: (337) 385-0405 |
| NPI Number | 1033006184 |
|---|---|
| Provider Enumeration Date | 06/20/2025 |
| Last Update Date | 07/15/2025 |
| Certification Date | 07/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033006184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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