Provider Demographics
NPI:1144790981
Name:FAILS, TRALAUNDA KAYE
Entity Type:Individual
Prefix:
First Name:TRALAUNDA
Middle Name:KAYE
Last Name:FAILS
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 1:209 RIDGECREST LOOP APT C
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5550
Mailing Address - Country:US
Mailing Address - Phone:407-567-8798
Mailing Address - Fax:
Practice Address - Street 1:209 RIDGECREST LOOP APT C
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5550
Practice Address - Country:US
Practice Address - Phone:407-567-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT-19-95834106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician