Most Relevant Information
Provider Data
| NPI Number: | 1003394180 |
| Provider Name: | GARY LEE RUSSELL LPCC-S, LICDC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | LICDC.162577 |
Most Important Dates
| Enumeration Date: | 08/01/2018 |
| Last Updated: | 02/15/2024 |
Provider Practice Location
151 MARION AVE
MANSFIELD
OH
449032223
Practice Location Phone/Fax
| Phone: | 4197749969 |
| Fax: |
Provider Mailing Location
33 S LEXINGTON SPRINGMILL RD
ONTARIO
OH
449061325
Provider Mailing Phone/Fax
| Phone: | 4195288008 |
| Fax: | 8774861420 |