NPIMap

Organization Active NPI

Beacon Therapy Associates, PC

  • Marriage & Family Therapist
  • Champlin, MN
National Provider Identifier
1407084031
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
BEACON THERAPY ASSOCIATES, PC
Practice address
11141 Zealand Ave N
Champlin, MN 55316
Phone
(763) 951-3091
Fax
(763) 951-3097
NPI assigned
Jun 22, 2009
Last updated
May 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shelly Marie Davenport, MS, LMFTNPI 1134166275
Title
President/Therapist
Phone
(763) 528-5235

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X Primary
Child & Adolescent Psychiatric/Mental Health Registered NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 163WP0807X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

11141 Zealand Ave N
Champlin, MN 55316

Mailing address

11141 Zealand Ave N
Champlin, MN 55316-3595
Phone (763) 951-3091

Other practice location 1

299 Coon Rapids Blvd NW
Coon Rapids, MN 55433-5832
Phone (763) 951-3091

Other practice location 2

4501 Allendale Dr
Saint Paul, MN 55127-6349
Phone (763) 951-3091

Other practice location 3

543 Coon Rapids Blvd NW
Coon Rapids, MN 55433-5500
Phone (763) 951-3091

Other practice location 4

3101 Old Highway 8
Roseville, MN 55113-1072
Phone (763) 951-3091

Other practice location 5

700 Twelve Oaks Center Dr
Wayzata, MN 55391-4401
Phone (763) 951-3091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130122000412 MN Part B Supplier - Clinic/Group Practice 4284887472 Receives reassigned benefits from 9 practitioners
Practice locations: Brooklyn Park, MN; Roseville, MN; Coon Rapids, MN; Champlin, MN

National Provider Directory

National Provider Directory

Locations

9201 75th Ave N
Brooklyn Park, MN 55428
Phone (763) 315-7000

11141 Zealand Ave N
Champlin, MN 55316
Phone (651) 653-0387

11157 Zealand Ave N
Champlin, MN 55316
Phone (320) 447-5559

299 Coon Rapids Blvd NW
Coon Rapids, MN 55433
Phone (763) 732-9851

543 Coon Rapids Blvd NW
Ste C
Coon Rapids, MN 55433
Phone (612) 423-6372

543 Coon Rapids Blvd NW
Minneapolis, MN 55433

3101 Old Highway 8
Roseville, MN 55113
Phone (612) 256-0999

4501 Allendale Dr
Saint Paul, MN 55127
Phone (651) 653-0387

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526601600000",
    "number": "1407084031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11141 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163595",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "55316",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "299 Coon Rapids Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335832",
            "country_code": "US",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4501 Allendale Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551276349",
            "country_code": "US",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "543 Coon Rapids Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335500",
            "country_code": "US",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3101 Old Highway 8",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "MN",
            "postal_code": "551131072",
            "country_code": "US",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Twelve Oaks Center Dr",
            "address_purpose": "LOCATION",
            "city": "Wayzata",
            "state": "MN",
            "postal_code": "553914401",
            "country_code": "US",
            "telephone_number": "763-951-3091",
            "fax_number": "763-951-3097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON THERAPY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2018-05-18",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT/THERAPIST",
        "authorized_official_telephone_number": "763-528-5235",
        "authorized_official_credential": "MS, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.