Provider Demographics
NPI:1366935884
Name:TRILIFE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:TRILIFE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LARAE
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-782-0210
Mailing Address - Street 1:601 MACK ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5923
Mailing Address - Country:US
Mailing Address - Phone:815-782-0210
Mailing Address - Fax:
Practice Address - Street 1:24020 W RIVERWALK CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-782-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-09
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010917261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)