Healthcare Provider Details

I. General information

NPI: 1134048994
Provider Name (Legal Business Name): MOONSTONE PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E SHAW AVE STE 139
FRESNO CA
93710-8100
US

IV. Provider business mailing address

1740 E SHEPHERD AVE APT 250
FRESNO CA
93720-5614
US

V. Phone/Fax

Practice location:
  • Phone: 559-478-6971
  • Fax: 559-774-1230
Mailing address:
  • Phone: 559-478-6971
  • Fax: 559-774-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KWONG
Title or Position: PSYD
Credential:
Phone: 559-478-6971