=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871415984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BE4AU
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 AVON CT
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-8526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-257-4488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 AVON CT
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-8526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-257-4488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MALANNA SIMMONS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 612-413-4087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------