Provider Demographics
NPI:1952921223
Name:REDEKOPP, NATHANIEL LUKAS (NCC, LPCC)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:LUKAS
Last Name:REDEKOPP
Suffix:
Gender:M
Credentials:NCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 10TH ST # 400
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6413
Mailing Address - Country:US
Mailing Address - Phone:505-331-4429
Mailing Address - Fax:
Practice Address - Street 1:1900 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5053
Practice Address - Country:US
Practice Address - Phone:575-249-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0210781101YM0800X
NMCTB-2022-0915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health