MEDICARE: ASCEND MIND AND BODY OF WESLEY CHAPEL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1679364251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCEND MIND AND BODY OF WESLEY CHAPEL LLC

Provider Business Mailing Address
First Line	:	832 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27724 CASHFORD CIR STE 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6963
Country	:	US
Telephone Number	:	813-670-3005
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID BRUCE WEBER
Credential	:
Telephone Number	:	863-698-1641

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	12/08/2025

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