MEDICARE: PERENNIAL COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164375077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERENNIAL COUNSELING

Provider Business Mailing Address
First Line	:	725 TASKER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1250
Country	:	US
Telephone Number	:	267-614-0726
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 TASKER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1250
Country	:	US
Telephone Number	:	267-614-0726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW SHIVE
Credential	:
Telephone Number	:	267-614-0726

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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