MEDICARE: BREAKING GROUND PSYCHOTHERAPY AND WELLNESS

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669323143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKING GROUND PSYCHOTHERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	8320 SHIRDON PL
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-8363
Country	:	US
Telephone Number	:	805-835-2078
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 21ST ST STE 204
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1722
Country	:	US
Telephone Number	:	805-835-2078
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALISHA DOZIER
Credential	:	LCSW
Telephone Number	:	805-835-9109

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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