Healthcare Provider Details

I. General information

NPI: 1477629640
Provider Name (Legal Business Name): TRILLIUM CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ELM GROVE RD SUITE 100
ELM GROVE WI
53122
US

IV. Provider business mailing address

500 ELM GROVE RD SUITE 100
ELM GROVE WI
53122
US

V. Phone/Fax

Practice location:
  • Phone: 262-782-2090
  • Fax: 262-782-2092
Mailing address:
  • Phone: 262-782-2090
  • Fax: 262-782-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2564
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2564
License Number StateWI

VIII. Authorized Official

Name: TERESA C ORTIZ
Title or Position: CLINICAL DIRECTOR PSYCHOTHERAPIST
Credential: LCSW
Phone: 262-782-2090