=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043175920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURORESILIENT PSYCHOTHERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2025
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 E BIDWELL ST STE 100
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-3561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-710-0503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 E BIDWELL ST STE 100
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-3561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-710-0503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER NAVA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 916-710-0503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------