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General NPI Number Information
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NPI Number | 1427392141
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Entity Type | Organization
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Legal Business Name | MULTISPECIALTY GROUP, LLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 8682 TOURMALINE BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-2420
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Country | US
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Telephone | 561-777-4402
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Fax | 689-348-4860
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Provider Business Mailing Address
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Address Line | 8682 TOURMALINE BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-2420
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Country | US
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Telephone | 305-505-6881
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Fax | 561-734-3158
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MRS. LISETTE TEN HOOPEN
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Credential |
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Telephone | 305-505-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | FL
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