Healthcare Provider Details

I. General information

NPI: 1487563888
Provider Name (Legal Business Name): TIDAL MENTAL HEALTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19225 8TH AVE NE STE 201
POULSBO WA
98370-5002
US

IV. Provider business mailing address

19225 8TH AVE NE STE 201
POULSBO WA
98370-5002
US

V. Phone/Fax

Practice location:
  • Phone: 510-633-3221
  • Fax:
Mailing address:
  • Phone: 510-633-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KARA RUBENS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LPCC, LMHC
Phone: 510-633-3221