Healthcare Provider Details

I. General information

NPI: 1770414666
Provider Name (Legal Business Name): MENA STAUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 ANSEL RD
CLEVELAND OH
44108-3321
US

IV. Provider business mailing address

1197 ANSEL RD
CLEVELAND OH
44108-3321
US

V. Phone/Fax

Practice location:
  • Phone: 216-421-0662
  • Fax: 844-593-7239
Mailing address:
  • Phone: 216-421-0662
  • Fax: 844-593-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: