Provider Demographics
NPI:1518085869
Name:MARTIN, GLENN ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 MINDEN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2420
Mailing Address - Country:US
Mailing Address - Phone:901-761-4787
Mailing Address - Fax:
Practice Address - Street 1:5583 MURRAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3841
Practice Address - Country:US
Practice Address - Phone:901-682-7388
Practice Address - Fax:901-682-7016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP 1921103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist