Healthcare Provider Details

I. General information

NPI: 1972642858
Provider Name (Legal Business Name): MARY L. SULLIVAN-TANSEY R.N., M.F.T., PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY S. TANSEY R.N., M.F.T., PSY. D

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD SUITE 'F'
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

12625 HESPERIA RD SUITE 'F'
VICTORVILLE CA
92395-7720
US

V. Phone/Fax

Practice location:
  • Phone: 760-955-1777
  • Fax: 760-955-2356
Mailing address:
  • Phone: 909-337-4467
  • Fax: 909-337-4467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 32835
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: