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Organization
BEACON THERAPY ASSOCIATES, PC
Active
Organization
BEACON THERAPY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY MARIE DAVENPORT MS, LMFT (PRESIDENT/THERAPIST)
(763) 528-5235
Entity
Organization
Contact information
Practice address
11141 ZEALAND AVE N, CHAMPLIN, MN 55316
(763) 951-3091
(763) 951-3097
Mailing address
11141 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
(763) 951-3091
(763) 951-3097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
—
NULL
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Enumeration date
06/22/2009
Last updated
05/18/2018
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