Healthcare Provider Details

I. General information

NPI: 1730054966
Provider Name (Legal Business Name): NORTH STAR MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 HILLS GATE CIR
SEYMOUR TN
37865-2900
US

IV. Provider business mailing address

4546 CHAPMAN HWY # 3027
KNOXVILLE TN
37920-4359
US

V. Phone/Fax

Practice location:
  • Phone: 509-964-4265
  • Fax: 509-302-2046
Mailing address:
  • Phone: 509-964-4265
  • Fax: 509-302-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMELIA JENSEN
Title or Position: OWNER/PROVIDER
Credential: LICSW
Phone: 509-964-4265