Healthcare Provider Details

I. General information

NPI: 1821909698
Provider Name (Legal Business Name): FORREST ARNIE WILLIS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 SW 103RD LN
DAVIE FL
33324-7466
US

IV. Provider business mailing address

1712 SW 103RD LN
DAVIE FL
33324-7466
US

V. Phone/Fax

Practice location:
  • Phone: 252-339-0285
  • Fax:
Mailing address:
  • Phone: 252-339-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: