Provider Demographics
NPI:1295698751
Name:ASCEND MIND AND BODY OF WESLEY CHAPEL LLC
Entity type:Organization
Organization Name:ASCEND MIND AND BODY OF WESLEY CHAPEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEV. & OPS
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:656-237-7722
Mailing Address - Street 1:832 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5202
Mailing Address - Country:US
Mailing Address - Phone:813-670-3005
Mailing Address - Fax:844-548-7006
Practice Address - Street 1:3971 MORAN RD STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4631
Practice Address - Country:US
Practice Address - Phone:813-670-3005
Practice Address - Fax:844-548-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCEND MIND AND BODY OF WESLEY CHAPEL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty