Provider Demographics
NPI:1821879578
Name:THE WILLIS GROUP- MOVING FORWARD
Entity Type:Organization
Organization Name:THE WILLIS GROUP- MOVING FORWARD
Other - Org Name:THE WILLIS GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS MBA
Authorized Official - Phone:214-927-6179
Mailing Address - Street 1:609 S GOLIAD ST UNIT 1524
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4051
Mailing Address - Country:US
Mailing Address - Phone:214-800-2846
Mailing Address - Fax:214-853-5663
Practice Address - Street 1:1200 MAIN STREET
Practice Address - Street 2:1407
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202
Practice Address - Country:US
Practice Address - Phone:214-800-2846
Practice Address - Fax:214-853-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty