Tanaya Moon Jackson, LPC
Individual provider Active NPI Professional Counselor · Casper, WY
NPI 1659558807 · NPPES record last updated Sep 25, 2025
Key facts
- NPI
- 1659558807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-1179 (WY)
- Practice address
- 5915 Thirty Three Mile Rd
Casper, WY 82604-9585 - Phone
- (307) 760-6340
- NPI assigned
- Jan 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1179 | WY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aktos Analytics, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-1179 | WY | Yes |
Addresses
Primary practice location
5915 Thirty Three Mile Rd
Casper, WY 82604-9585
Mailing address
5915 Thirty Three Mile Rd
Casper, WY 82604-9585
Phone (307) 760-6340
Other providers in Casper, WY
- Alicja Kinga Iznerowicz
- J L Glover, LLC
- Juliann Jaber
- April Dawn Jacka
- Lauren Jackson
- Jayne Esther Jacobs
- Dana Jacoby
- Mary Sue Jacques
- James a Knott MD PC
- James F Hoag DDS PC
All providers in Casper, WY · Professional Counselor in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.