There are still hundreds of conversion therapy practitioners in the U.S., despite many state and local laws limiting the discredited and harmful practice of trying to change a person’s sexual orientation or gender identity.

A Trevor Project report released Tuesday, “It’s Still Happening,” identified more than 1,320 conversion therapy practitioners in 48 states and the District of Columbia. More than 20 states, D.C., and numerous cities and counties have enacted laws barring licensed professionals from subjecting minors to such therapy, but those laws don’t affect what counselors offer adult clients, nor do they affect the work of unlicensed practitioners, including many of those who are affiliated with a religious institution. Some faith-based therapists, however, do hold state licenses.

Many of the therapists the Trevor Project identified operate in states that have restrictions, according to the report. And the number is likely an undercount, given that “conversion therapy is increasingly underground and conducted in secret, with many practitioners not publicly advertising their services in a way that can be documented,” the document states.

“While public awareness of the harm and unscientific foundation of conversion therapy has grown dramatically over the years, many believe it to be a thing of the past. This new report shatters this misperception, revealing troubling evidence that conversion therapy is far from being a relic of history,” Casey Pick, director of law and policy for the Trevor Project, said in a press release.“Conversion therapy practitioners are widespread across the country, with many of them utilizing their licenses and credentials to attempt to legitimize the dangerous and unethical practices they aim to impose on vulnerable LGBTQ+ youth. The findings of this report underscore the urgent need for policymakers, state licensing boards, professional associations, accreditation agencies, healthcare leaders, and faith communities to take action today to end this insidious and exploitative industry.”

The Trevor Project’s researchers identified “more than 600 practitioners who hold active professional licenses and over 700 practitioners who operate in a ministerial (official religious) capacity,” the report says. They performed online searches and reviewed all leads that they uncovered.

Pennsylvania, Texas, Minnesota, Missouri, and Ohio had the most identified licensed and unlicensed practitioners, in descending order. Minnesota is the only state in this group with a ban on conversion therapy for minors. The South had the largest proportion of the providers identified — 33 percent — followed by the Midwest, with 28 percent. Hawaii and Vermont were the only states with no identified practitioners.

Conversion therapy has been condemned as ineffective and harmful by every major medical and mental health group in the U.S. The American Psychological Association has found it is “associated with an extensive list of long-lasting social and emotional consequences,” the report notes. “These include depression, anxiety, suicidality, substance abuse, a range of post-traumatic responses, loss of connection to community, damaged familial relationships, self-blame, guilt, and shame.”

It is rooted in the idea that being lesbian, gay, bisexual, transgender, or queer is a mental illness that needs to be “cured” — again, something rejected by leaders of the mental health field.

To end conversion therapy, Trevor Project officials call for more state laws limiting the practice and better enforcement of those that exist. They also urge the federal government to take action through regulatory bodies and for Congress to pass legislation classifying conversion therapy as consumer fraud — such legislation has been introduced but has yet to pass.

“Lifting the curtain and exposing this underground practice is a shocking realization of how much work still needs to be done to put a stop to the deeply entrenched conversion ‘therapy’ industry,” Troy Stevenson, director of state advocacy campaigns for the Trevor Project, said. “Governors and state lawmakers have a particularly unique responsibility to act — and act urgently. They have extraordinary power by way of legislation, regulation and executive action to end this abusive and pervasive practice across the country.”

“Every parent wants their child to be well and to thrive, which is what makes this report so astonishing, and frankly, frightening,” added Brian K. Bond, CEO of PFLAG National, a partner with the Trevor Project in the movement to end conversion therapy since 2012. “When therapists, counselors and trusted faith leaders misrepresent their services, families pay the price. Until lawmakers take action to end these practices, PFLAG National advises LGBTQ+ people and families to avoid services that promote therapies using terms such as ‘conversion,’ ‘reparative,’ ‘reintegrative,’ ‘unwanted same-sex attraction,’ ‘sexual attraction fluidity exploration,’ and ‘rapid-onset gender dysphoria.’’’