Provider Demographics
NPI:1932254521
Name:COURSOL, ALLAN JOSEPH (LP)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JOSEPH
Last Name:COURSOL
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2813
Mailing Address - Country:US
Mailing Address - Phone:507-345-7966
Mailing Address - Fax:
Practice Address - Street 1:209 S 2ND ST
Practice Address - Street 2:SUITE 306
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3626
Practice Address - Country:US
Practice Address - Phone:507-387-1350
Practice Address - Fax:507-387-6605
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP28646OtherHEALTH PARTNERS
MN6H523COOtherBLUE CROSS
MN1021816OtherPREFERRED ONE
MN114892OtherUCARE
MN6145483OtherUNITED BEHAVORIAL HEALTH