Provider Demographics
NPI:1174234454
Name:YARBROUGH, JAELA K
Entity type:Individual
Prefix:
First Name:JAELA
Middle Name:K
Last Name:YARBROUGH
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 1:3517 PINE AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35221-1446
Mailing Address - Country:US
Mailing Address - Phone:205-240-5948
Mailing Address - Fax:
Practice Address - Street 1:3517 PINE AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35221-1446
Practice Address - Country:US
Practice Address - Phone:205-240-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician