MEDICARE: MOONSTONE THERAPY A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063343663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSTONE THERAPY A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 10074
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93389-0074
Country	:	US
Telephone Number	:	559-579-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 NORTHGATE BLVD STE 4
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1227
Country	:	US
Telephone Number	:	559-579-0040
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR AND OWNER
Name	:	GINGER MOYER
Credential	:	LMFT
Telephone Number	:	559-579-0040

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/28/2026

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