Healthcare Provider Details

I. General information

NPI: 1912708850
Provider Name (Legal Business Name): WILD AND WISE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S RANDOLPH ST
WEEPING WATER NE
68463-4209
US

IV. Provider business mailing address

663 N 132ND ST # 7271
OMAHA NE
68154-4031
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-8476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN P HILLER
Title or Position: OWNER
Credential:
Phone: 402-413-8476