MEDICARE: WILD & PRECIOUS THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598607228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD & PRECIOUS THERAPY LLC

Provider Business Mailing Address
First Line	:	6712 MARK CT
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-2829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17251 W 12 MILE RD STE 200
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2140
Country	:	US
Telephone Number	:	916-216-0861
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NIKU RICE
Credential	:	LMSW
Telephone Number	:	916-216-0861

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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