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General NPI Number Information
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NPI Number | 1902769193
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Entity Type | Organization
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Legal Business Name | ASCEND MIND AND BODY OF WESLEY CHAPEL LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 832 S FLORIDA AVE SUITE 1, 2ND FLOOR
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City | LAKELAND
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State | FL
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Zip | 33801-5202
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Country | US
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Telephone | 813-670-3005
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Fax | 844-548-7006
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Provider Business Mailing Address
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Address Line | 832 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33801-5202
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Country | US
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Telephone | 813-670-3005
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Fax | 844-548-7006
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Authorized Official
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Title or Position | DIRECTOR OF BUS. DEV. & OPS
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Name | SHAUNA HORN
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Credential |
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Telephone | 656-237-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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