# BEACON THERAPY ASSOCIATES, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407084031
- **Authorized official:** SHELLY MARIE DAVENPORT MS, LMFT (PRESIDENT/THERAPIST)
- **Authorized official phone:** (763) 528-5235

## Contact information

- **Practice address:** 11141 ZEALAND AVE N, CHAMPLIN, MN 55316
- **Practice address phone:** (763) 951-3091
- **Practice address fax:** (763) 951-3097
- **Mailing address:** 11141 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
- **Mailing address phone:** (763) 951-3091
- **Mailing address fax:** (763) 951-3097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 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