Provider Demographics
NPI:1679301493
Name:FAILLACE-GARREN, ZANE
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:FAILLACE-GARREN
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2561
Mailing Address - Country:US
Mailing Address - Phone:352-613-8032
Mailing Address - Fax:
Practice Address - Street 1:27357 FRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7306
Practice Address - Country:US
Practice Address - Phone:352-345-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362963106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician