Provider Demographics
NPI:1417326281
Name:TANSEY-BLUST, DOLORES
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:TANSEY-BLUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32770 OLD WOMAN SPRINGS RD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUCERNE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92356
Mailing Address - Country:US
Mailing Address - Phone:760-248-6612
Mailing Address - Fax:
Practice Address - Street 1:32770 OLD WOMAN SPRINGS RD.
Practice Address - Street 2:SUITE 222
Practice Address - City:LUCERNE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92356
Practice Address - Country:US
Practice Address - Phone:760-248-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist