Healthcare Provider Details

I. General information

NPI: 1922717065
Provider Name (Legal Business Name): RICKI BRIANA MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7158 MILLERS GLEN WAY
MEMPHIS TN
38125-4170
US

IV. Provider business mailing address

1910 MADISON AVE # 2358
MEMPHIS TN
38104-2620
US

V. Phone/Fax

Practice location:
  • Phone: 901-413-8420
  • Fax:
Mailing address:
  • Phone: 901-414-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10377
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: