Provider Demographics
NPI:1497279822
Name:TRAMMELL, LESLIE RUTH (LCPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RUTH
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:RUTH
Other - Last Name:TRAMMELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:5609 BREECHER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2045
Mailing Address - Country:US
Mailing Address - Phone:702-219-4907
Mailing Address - Fax:
Practice Address - Street 1:9418 W LAKE MEAD BLVD OFC 308
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-608-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional