Provider Demographics
NPI:1003965617
Name:MARTIN, RICKI R (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:RICKI
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 MAHONING AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-797-0036
Mailing Address - Fax:330-797-0034
Practice Address - Street 1:5212 MAHONING AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MAHONING
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-797-8800
Practice Address - Fax:330-797-8808
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7022689OtherAETNA
OH000000388413OtherBCBS