Healthcare Provider Details

I. General information

NPI: 1639002538
Provider Name (Legal Business Name): SPIRIT HORSE RANCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 S 204TH ST
GRETNA NE
68028-6228
US

IV. Provider business mailing address

14624 S 204TH ST
GRETNA NE
68028-6228
US

V. Phone/Fax

Practice location:
  • Phone: 402-880-1106
  • Fax:
Mailing address:
  • Phone: 402-880-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINE D TEVIS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 402-880-1106