Individual
DR. TANAYA MOON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5915 THIRTY THREE MILE RD, CASPER, WY 82604-9585
(307) 760-6340
Mailing address
5915 THIRTY THREE MILE RD, CASPER, WY 82604-9585
(307) 760-6340
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-1179
WY
Other
Enumeration date
01/29/2008
Last updated
09/25/2025
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