| Organization Name: | BAYOU WELLNESS, LLC |
| NPI Number: | 1083096036 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREA BURKS (OWNER) |
| Mailing Address: | 69 Bay Bridge Dr Suite H Gulf Breeze |
| State: | FL US |
| Postal Code: | 325614468 |
| Phone Number: | 8503247912 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2015 |
| NPI Last Update Date: | 06/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH12035 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |