Healthcare Provider Details

I. General information

NPI: 1104620533
Provider Name (Legal Business Name): CHYLA SEPHFUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GRAHAM DR
ATHENS OH
45701-1430
US

IV. Provider business mailing address

PO BOX 132
ATHENS OH
45701-0132
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-8293
  • Fax: 800-321-8293
Mailing address:
  • Phone: 800-321-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2511994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: