Provider Demographics
NPI:1437848603
Name:TIP OF THE SPEAR CLINICAL THERAPY GROUP LICENSED CLINICAL SOCIAL WOR
Entity type:Organization
Organization Name:TIP OF THE SPEAR CLINICAL THERAPY GROUP LICENSED CLINICAL SOCIAL WOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VITO
Authorized Official - Last Name:DESENA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PSYD
Authorized Official - Phone:951-297-7773
Mailing Address - Street 1:25109 JEFFERSON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8117
Mailing Address - Country:US
Mailing Address - Phone:951-297-7773
Mailing Address - Fax:951-755-1694
Practice Address - Street 1:24116 TUSCANY AVE UNIT 1901
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1297
Practice Address - Country:US
Practice Address - Phone:360-720-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty