MEDICARE: KASSANDRA BOORTZ, LMFT, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275485369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KASSANDRA BOORTZ, LMFT, LLC

Provider Business Mailing Address
First Line	:	2950 BROAD ST # 1088
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6702
Country	:	US
Telephone Number	:	805-888-1732
Fax Number	:	888-649-9179

Provider Business Practice Location Address
First Line	:	881 PRIMROSE LN
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-5410
Country	:	US
Telephone Number	:	805-888-0912
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	KASSANDRA DAWN BOORTZ
Credential	:	LMFT
Telephone Number	:	805-888-1732

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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