National Provider Identifier Database

SOUTHEAST ALABAMA YOUTH SERVICES
Professional


Contact Information

SOUTHEAST ALABAMA YOUTH SERVICES
2856 HORACE SHEPARD DR.
DOTHAN, AL36303
Phone: 334-983-8377
Fax: 334-983-1289
Website:
Specialty Taxonomy Code
* Professional 101YP2500X
Community/Behavioral Health 251S00000X

* Indicates primary specialty

NPI Profile & details for SOUTHEAST ALABAMA YOUTH SERVICES

NPI Number 1790575256
Legal business name
LBN
SOUTHEAST ALABAMA YOUTH SERVICES
Authorized official TABITHA BRANNON - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart Yes
Enumeration date 05/08/2025
Last updated 05/08/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • AL Medicaid: 339100015

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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