Healthcare Provider Details

I. General information

NPI: 1073449351
Provider Name (Legal Business Name): MARK ARCHILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DISCOVERY DR STE 109
BOZEMAN MT
59718-4134
US

IV. Provider business mailing address

408 ENTERPRISE BLVD UNIT 11
BOZEMAN MT
59718-6884
US

V. Phone/Fax

Practice location:
  • Phone: 406-595-3066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-89635
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: