Healthcare Provider Details

I. General information

NPI: 1699594283
Provider Name (Legal Business Name): SELVA WELLNESS COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W 6TH ST # A
AUSTIN TX
78703-5059
US

IV. Provider business mailing address

12824 WILLOWGROVE LN
MANOR TX
78653-2589
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-6797
  • Fax:
Mailing address:
  • Phone: 443-949-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA MARIA RODRIGUEZ
Title or Position: FOUNDER, THERAPIST, COACH
Credential: MS, LPC
Phone: 443-949-6797