Healthcare Provider Details

I. General information

NPI: 1891591293
Provider Name (Legal Business Name): BAILI ALEXIS DIEFENBACH M.ED., LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EAGLE NEST DR
PADUCAH KY
42003-9435
US

IV. Provider business mailing address

230 HEATHER LN
LEDBETTER KY
42058-9735
US

V. Phone/Fax

Practice location:
  • Phone: 270-898-1293
  • Fax: 270-898-1187
Mailing address:
  • Phone: 618-218-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number299334
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: