Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Amani Ayisha Jackson

Individual provider Professional Counselor · NPI 1639742158

Amani Ayisha Jackson is a Mental Health Counselor in Fairbanks, Alaska. Qualified in 2019, 7 years ago. Practices with Southeast Alaska Regional Health Consortium, a 368-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Alaska.

Years since qualifying
7
Licensed in
AK
In the registry since
2021
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1825 Marika Rd
Fairbanks, AK 99709-5521
Phone: (907) 474-0890
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 222527 (AK)
Community Health Worker Taxonomy 172V00000X

Record details

NPI number1639742158
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 22, 2021
Last updated in NPPESMay 9, 2024
Certification dateMay 9, 2024
Mailing address6631 E 9th Ave, Anchorage, AK 99504-1725

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Southeast Alaska Regional Health Consortium — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fairbanks