Provider Demographics
NPI:1235786955
Name:PARNHAM, MARY STOVALL (BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:STOVALL
Last Name:PARNHAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROLINE
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5040
Mailing Address - Country:US
Mailing Address - Phone:870-464-1337
Mailing Address - Fax:
Practice Address - Street 1:702 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5040
Practice Address - Country:US
Practice Address - Phone:870-464-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-21-48088103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst