Individual
GARY LEE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LICDC
Contact information
Practice address
151 MARION AVE, MANSFIELD, OH 44903-2223
(419) 774-9969
Mailing address
33 S LEXINGTON SPRINGMILL RD, ONTARIO, OH 44906-1325
(419) 528-8008
(877) 486-1420
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.162577
OH
101YM0800X
Mental Health Counselor
Primary
E.2001844-SUPV
OH
Other
Enumeration date
08/01/2018
Last updated
02/15/2024
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