Healthcare Provider Details

I. General information

NPI: 1871472167
Provider Name (Legal Business Name): MOUNTAINS AND WAVES MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BANK ST STE 310
MISSOULA MT
59802-4413
US

IV. Provider business mailing address

125 BANK ST STE 310
MISSOULA MT
59802-4413
US

V. Phone/Fax

Practice location:
  • Phone: 406-220-6110
  • Fax: 406-549-7559
Mailing address:
  • Phone: 406-220-6110
  • Fax: 406-549-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK MCGRATH
Title or Position: OWNER/PROVIDER
Credential: PMHNP
Phone: 406-220-6110