MEDICARE: MENA STAUCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCAPRE.195635	OH

General Provider Information

NPI Number	:	1770414666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENA STAUCH

Provider Business Mailing Address
First Line	:	1197 ANSEL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3321
Country	:	US
Telephone Number	:	216-421-0662
Fax Number	:	844-593-7239

Provider Business Practice Location Address
First Line	:	1197 ANSEL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3321
Country	:	US
Telephone Number	:	216-421-0662
Fax Number	:	844-593-7239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ MENA STAUCH ” Practice Location

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