Provider Demographics
NPI:1881381705
Name:ENGELBRECHT, NATHAN (LSAA, CCSS)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:ENGELBRECHT
Suffix:
Gender:M
Credentials:LSAA, CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 CLAUDE DOVE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4504
Mailing Address - Country:US
Mailing Address - Phone:575-313-3283
Mailing Address - Fax:575-323-3046
Practice Address - Street 1:303 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2590
Practice Address - Country:US
Practice Address - Phone:575-523-0111
Practice Address - Fax:575-571-4130
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0539101YA0400X
NM175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35605081Medicaid
NM29286310Medicaid
NM98220578Medicaid
NM42978351Medicaid