Beacon Therapy Associates, PC
Organization Active NPI Marriage & Family Therapist · Champlin, MN
NPI 1407084031 · NPPES record last updated May 18, 2018
Key facts
- NPI
- 1407084031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Marriage & Family Therapist 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
- Organization subpart
- No
Authorized official
- Name
- Shelly Marie Davenport, MS, LMFT
- Title
- President/Therapist
- Phone
- (763) 528-5235
Practitioners 26
-
Shelly Marie Davenport, MS, LMFT
-
Loren Bergstedt, LPC, LADC
-
Amy Bianchi-Rossi, LPCC
-
Jan Marie D'Ambrosio, MA, LMFT
-
Nancy Jean Dorman, LAMFT
-
Jeanne Ketola, MA LPCC
-
Christopher David Emery, MSW, LICSW
-
Krista Jane Hultgren, GNP
-
Kysa Lorenc Lubovich, LMFT
-
Michelle Lee Rogers, MSW, LGSW
-
Shannon Lee Royer, COUNSELOR
-
Christina A Evensen, LPC, NCC
-
Daniel Golat, LMFT
-
Nathan Klein, LSW
-
Suzanne M Lee, DNP
-
Kelsey Malinda Middleton, LMFT
-
Elizabeth Bester Mihalchick, LPCC, LADC, LSC
-
Susan Riekels, LPC
-
Gary R Sandberg, M.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
7040 Lakeland Ave N
Ste 211
Brooklyn Park, MN 55428
Phone (763) 442-7353
11141 Zealand Ave N
Champlin, MN 55316
Phone (651) 653-0387
543 Coon Rapids Blvd NW
Ste C
Coon Rapids, MN 55433
Phone (612) 423-6372
299 Coon Rapids Blvd NW
Coon Rapids, MN 55433
Phone (763) 732-9851
543 Coon Rapids Blvd NW
Minneapolis, MN 55433
1935 County Road B2 W
Ste 130
Roseville, MN 55113
3101 Old Highway 8
Roseville, MN 55113
Phone (612) 256-0999
4501 Allendale Dr
Saint Paul, MN 55127
Phone (651) 653-0387
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Marriage & Family Therapist |
106H00000X | Yes | ||
| Child & Adolescent Psychiatric/Mental Health Registered Nurse |
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
3101 Old Highway 8
Roseville, MN 55113-1072
Phone (763) 951-3091
Other practice location 2
299 Coon Rapids Blvd NW
Coon Rapids, MN 55433-5832
Phone (763) 951-3091
Other practice location 3
4501 Allendale Dr
Saint Paul, MN 55127-6349
Phone (763) 951-3091
Other practice location 4
700 Twelve Oaks Center Dr
Wayzata, MN 55391-4401
Phone (763) 951-3091
Other practice location 5
543 Coon Rapids Blvd NW
Coon Rapids, MN 55433-5500
Phone (763) 951-3091
Other providers in Champlin, MN
- Carol Ann Bahnemann
- Bammert Family Chiropractic, LLC
- Charles Bammert
- Angela Danielle Bancroft
- Krista S Bauer-Abrahamson
- Bechard Chiropractic Inc
- Dean Bechard
- Becoming You Therapy LLC
- Amirali Behdani
- Yohannes Bekelcho
All providers in Champlin, MN · Marriage & Family Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.