Healthcare Provider Details

I. General information

NPI: 1265394779
Provider Name (Legal Business Name): TIDEPOOL MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 POLK ST STE 10
PORT TOWNSEND WA
98368-6739
US

IV. Provider business mailing address

210 POLK ST STE 10
PORT TOWNSEND WA
98368-6739
US

V. Phone/Fax

Practice location:
  • Phone: 360-928-6649
  • Fax: 920-605-8991
Mailing address:
  • Phone: 360-928-6649
  • Fax: 920-605-8991

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: BRENDA G FRANCIS
Title or Position: FOUNDER
Credential: DNP PMHNP-BC
Phone: 920-296-5104