Organization
BAYOU ROOTS THERAPY COLLECTIVE LLC
Active
Organization
BAYOU ROOTS THERAPY COLLECTIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE HERHOLD (OWNER)
(337) 278-0786
Entity
Organization
Contact information
Practice address
117 HEYMANN BLVD STE 14, LAFAYETTE, LA 70503-2397
(337) 385-0405
(337) 385-0405
Mailing address
PO BOX 55, GULF SHORES, AL 36547-0055
(337) 278-0786
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9349
LOUISIANA BOARD OF SOCIAL WORK EXAMINERS
LA
Enumeration date
06/20/2025
Last updated
04/28/2026
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