Healthcare Provider Details

I. General information

NPI: 1841138799
Provider Name (Legal Business Name): AMANDA SIVONEY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 POLARIS DR STE 1
LAREDO TX
78041-2054
US

IV. Provider business mailing address

6510 POLARIS DR STE 1
LAREDO TX
78041-2054
US

V. Phone/Fax

Practice location:
  • Phone: 956-962-4198
  • Fax: 866-387-1142
Mailing address:
  • Phone: 956-962-4198
  • Fax: 866-387-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95657
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: