Individual
TRACY LATERIA BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LCADC, CPC-I
Contact information
Practice address
1901 S JONES BLVD, LAS VEGAS, NV 89146-1260
(702) 486-7865
Mailing address
500 E WARM SPRINGS RD STE 100, LAS VEGAS, NV 89119-4345
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CI5354
NV
101YA0400X
Addiction (Substance Use Disorder) Counselor
07366-LCI
NV
Other
Enumeration date
04/03/2023
Last updated
10/14/2025
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