Healthcare Provider Details

I. General information

NPI: 1063343663
Provider Name (Legal Business Name): MOONSTONE THERAPY A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 NORTHGATE BLVD STE 4
SACRAMENTO CA
95834-1227
US

IV. Provider business mailing address

PO BOX 10074
BAKERSFIELD CA
93389-0074
US

V. Phone/Fax

Practice location:
  • Phone: 559-579-0040
  • Fax:
Mailing address:
  • Phone: 559-579-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GINGER MOYER
Title or Position: CLINICAL DIRECTOR AND OWNER
Credential: LMFT
Phone: 559-579-0040