Provider Demographics
NPI:1386278844
Name:PARKS, SANDRA KAY
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7534
Mailing Address - Country:US
Mailing Address - Phone:501-847-2835
Mailing Address - Fax:501-847-6809
Practice Address - Street 1:408 OFFICE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7536
Practice Address - Country:US
Practice Address - Phone:501-847-2835
Practice Address - Fax:501-847-6809
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR83-31E101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor