Organization · Type 2 NPI

Sovereign Self, LLC

Mental Health Counselor · Albuquerque, NM

NPI number 1366237901 Active

Practice location

3620 Wyoming Blvd NE Ste 218
Albuquerque, NM 87111-3289

Specialties and licenses

Taxonomy	Code	License
Mental Health Counselor Primary	101YM0800X	None listed

Mental Health Counselor: Definition to come...

Another provider at this address

Nina Wilson, LPCProfessional Counselor Albuquerque, NM NPI 1063878924

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NPI record

NPI: 1366237901
Entity type: Organization (Type 2)
Issued: Apr 14, 2025
Last updated: Sep 16, 2025
Status: Active

Other names

Sovereign Self Mental Health · doing business as
Sovereign Self Mental Health and Self Care Lounge · doing business as

Authorized official

Nina Wilson, LPC, LPCC
Owner
(308) 778-7020

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1366237901

Sovereign Self, LLC's National Provider Identifier is 1366237901, issued on Apr 14, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Albuquerque, NM. The record was last updated on Sep 16, 2025.