Healthcare Provider Details

I. General information

NPI: 1801702246
Provider Name (Legal Business Name): TRELLIS MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 LARA RD
NORMAL IL
61761-4035
US

IV. Provider business mailing address

717 LARA RD
NORMAL IL
61761-4035
US

V. Phone/Fax

Practice location:
  • Phone: 217-637-0268
  • Fax:
Mailing address:
  • Phone: 217-637-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GRAHAM
Title or Position: FOUNDING DIRECTOR & COUNSELOR
Credential: MA, NCC, LCPC
Phone: 217-637-0268