| Beacon Therapy Associates, Pc | |
|
11141 Zealand Ave N Champlin MN 55316 | |
| (763) 951-3091 | |
| (763) 951-3097 |
| Full Name | Beacon Therapy Associates, Pc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11141 Zealand Ave N, Champlin, Minnesota |
| Authorized Official Name and Position | Shelly Marie Davenport (PRESIDENT/THERAPIST) |
| Authorized Official Contact | 7635285235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Therapy Associates, Pc 11141 Zealand Ave N Champlin MN 55316-3595 Ph: (763) 951-3091 | Beacon Therapy Associates, Pc 11141 Zealand Ave N Champlin MN 55316 Ph: (763) 951-3091 |
| NPI Number | 1407084031 |
|---|---|
| Provider Enumeration Date | 06/22/2009 |
| Last Update Date | 05/18/2018 |
| Medicare PECOS PAC ID | 4284887472 |
|---|---|
| Medicare Enrollment ID | O20130122000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407084031 | NPI | - | NPPES |
| Provider Name | Krista J Naber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699752535 PECOS PAC ID: 4486553732 Enrollment ID: I20040107000066 |
| Provider Name | Christopher D Emery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477693851 PECOS PAC ID: 6709971542 Enrollment ID: I20071009000235 |
| Provider Name | Jan Marie D'ambrosio |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1538625256 PECOS PAC ID: 5092160507 Enrollment ID: I20231018000584 |
| Provider Name | Shelly Marie Davenport |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134166275 PECOS PAC ID: 2961655162 Enrollment ID: I20231218002583 |
| Provider Name | Sean Brandon Miller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1073142725 PECOS PAC ID: 4789033648 Enrollment ID: I20231218002687 |
| Provider Name | Kysa Lorenc Lubovich |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1396197117 PECOS PAC ID: 0446609325 Enrollment ID: I20231218003451 |
| Provider Name | Nancy Jean Dorman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447594221 PECOS PAC ID: 0446600332 Enrollment ID: I20231218003868 |
| Provider Name | Amy Bianchi-rossi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679815997 PECOS PAC ID: 6901252402 Enrollment ID: I20240115001349 |
| Provider Name | Loren Duane Bergstedt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538570726 PECOS PAC ID: 5294183828 Enrollment ID: I20240116002058 |
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K.i.d.s.&family Therapy,llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11157 Zealand Ave N, Champlin, MN 55316 Phone: 763-710-9949 |