Individual
MISS CRYSTAL M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, CDCA
Contact information
Practice address
1338 W 4TH ST, ONTARIO, OH 44906-1828
(419) 528-5994
Mailing address
843 ANDOVER RD, MANSFIELD, OH 44907-1911
(419) 528-5994
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C15000630
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA162724
OH
101YM0800X
Mental Health Counselor
C1500630
OH
101YM0800X
Mental Health Counselor
Primary
E.2102678
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
07/01/2015
Last updated
07/21/2022
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