Healthcare Provider Details

I. General information

NPI: 1154297281
Provider Name (Legal Business Name): TRACEY MRACHEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S RUSSELL ST
MISSOULA MT
59801-6621
US

IV. Provider business mailing address

PO BOX 5102
MISSOULA MT
59806-5102
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-4167
  • Fax:
Mailing address:
  • Phone: 406-493-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBHACLCLIC81557
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: