=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548106628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHT MOON THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2026
-----------------------------------------------------
Last Update Date | 04/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4355 N RIO CANCION APT 343
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85718-7116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-261-9705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 W UNION HILLS DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-5163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-261-9705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | CAILA L LIPOVSKY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 520-261-9705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------