Tracy Lateria Bannerman, MS, LCADC, CPC-I
Individual provider Active NPI Counselor · Las Vegas, NV
NPI 1699470294 · NPPES record last updated Oct 14, 2025
Key facts
- NPI
- 1699470294
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- CI5354 (NV)
- Practice address
- 1901 S Jones Blvd
Las Vegas, NV 89146-1260 - Phone
- (702) 486-7865
- NPI assigned
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CI5354 | NV | MD | Counselor |
| 07366-LCI | NV | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CI5354 | NV | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 07366-LCI | NV |
Addresses
Primary practice location
1901 S Jones Blvd
Las Vegas, NV 89146-1260
Mailing address
500 E Warm Springs Rd Ste 100
Las Vegas, NV 89119-4345
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 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.