Provider Demographics
NPI:1114233889
Name:PARKS, BAMBI MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:MARIE
Last Name:PARKS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MURPHY DR STE 11
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6198
Mailing Address - Country:US
Mailing Address - Phone:501-273-1631
Mailing Address - Fax:
Practice Address - Street 1:701 MURPHY DR STE 11
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6198
Practice Address - Country:US
Practice Address - Phone:501-273-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5190-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical