Provider Demographics
NPI:1346311024
Name:TEVIS, KRISTINE D (LIMHP, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:D
Last Name:TEVIS
Suffix:
Gender:F
Credentials:LIMHP, LPC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:D
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 F STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2807
Mailing Address - Country:US
Mailing Address - Phone:402-397-9866
Mailing Address - Fax:402-397-1404
Practice Address - Street 1:5115 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2807
Practice Address - Country:US
Practice Address - Phone:402-397-9866
Practice Address - Fax:402-397-1404
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2829101YM0800X
NE1480101YP2500X
CO0017537101YP2500X
NE61101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076510700Medicaid