| Doctor Name: | MR. RUSSELL RAY EXLOS-RABER |
| NPI Number: | 1104205079 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | C.1400059 |
| Business Practice Address: | 777 S Washington St Tiffin, OH - 448833325 |
| Business Phone Number: | 4194484094 |
| Business Fax Number: | |
| Mailing Address: | 1313 E Cole Rd, FREMONT |
| State: | OH |
| Postal Code: | 434208868 |
| Phone Number: | 4193079092 |
| Fax Number: | |
| NPI Enumeration Date: | 05/26/2015 |
| NPI Last Update Date: | 05/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C.1400059 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |