Provider Demographics
NPI:1548940679
Name:CALLAHAN, MYLA CHEYENNE (CDCA, OCPSA)
Entity type:Individual
Prefix:
First Name:MYLA
Middle Name:CHEYENNE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CDCA, OCPSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 STEUBENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2401
Mailing Address - Country:US
Mailing Address - Phone:740-439-4532
Mailing Address - Fax:740-439-1031
Practice Address - Street 1:1009 STEUBENVILLE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2401
Practice Address - Country:US
Practice Address - Phone:740-439-4532
Practice Address - Fax:740-439-1031
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.190650101YA0400X
OHOCPSA.162197405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional