Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27724 CASHFORD CIR STE 102
WESLEY CHAPEL FL
33544-6963
US

IV. Provider business mailing address

832 S FLORIDA AVE
LAKELAND FL
33801-5202
US

V. Phone/Fax

Practice location:
  • Phone: 813-670-3005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BRUCE WEBER
Title or Position: CEO
Credential:
Phone: 863-698-1641