Healthcare Provider Details

I. General information

NPI: 1457201956
Provider Name (Legal Business Name): STEADFAST HEALTH PROFESSIONAL SERVICES OF OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 106
CLEVELAND OH
44104-3833
US

IV. Provider business mailing address

11201 SHAKER BLVD STE 106
CLEVELAND OH
44104-3833
US

V. Phone/Fax

Practice location:
  • Phone: 866-935-0936
  • Fax:
Mailing address:
  • Phone: 866-935-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVIS STEPHEN
Title or Position: COO
Credential: MD
Phone: 615-987-5512