Organization
SOUTHEAST ALABAMA YOUTH SERVICES
Active
Parent organization
SOUTHEAST ALABAMA YOUTH SERVICES
Other names
PSB Outpatient Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST ALABAMA YOUTH SERVICES
Authorized official
MRS. TABITHA S BRANNON LPC-S (EXECUTIVE DIRECTOR)
(334) 983-8377
Entity
Organization
Contact information
Practice address
2856 HORACE SHEPARD DR., DOTHAN, AL 36303
(334) 983-8377
(334) 983-1289
Mailing address
2856 HORACE SHEPARD DR., DOTHAN, AL 36303
(334) 983-8377
(334) 983-1289
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339100015
—
AL
Enumeration date
05/08/2025
Last updated
05/08/2025
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