Healthcare Provider Details

I. General information

NPI: 1417326281
Provider Name (Legal Business Name): DOLORES TANSEY-BLUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 08/10/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32770 OLD WOMAN SPRINGS RD. SUITE 222
LUCERNE VALLEY CA
92356
US

IV. Provider business mailing address

32770 OLD WOMAN SPRINGS RD. SUITE C
LUCERNE VALLEY CA
92356
US

V. Phone/Fax

Practice location:
  • Phone: 760-248-6612
  • Fax:
Mailing address:
  • Phone: 760-248-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: