1932254521 NPI number — DR. ALLAN JOSEPH COURSOL LP

Table of content: AMY IRENE RALSTON-BEIKE LPC, MS (NPI 1548283963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932254521 NPI number — DR. ALLAN JOSEPH COURSOL LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURSOL
Provider First Name:
ALLAN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932254521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1537 NOTTINGHAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56003-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-345-7966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-3626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-387-1350
Provider Business Practice Location Address Fax Number:
507-387-6605
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LP1433 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HP28646 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6H523CO . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1021816 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 114892 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6145483 . This is a "UNITED BEHAVORIAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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