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General NPI Number Information
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NPI Number | 1497455059
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Entity Type | Individual
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Provider Name | DAVID RAY BAISDEN M.ED, LPCC
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Gender | Male
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 1029 COLLEGE AVE STE 101B
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City | JACKSON
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State | KY
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Zip | 41339-1073
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Country | US
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Telephone | 606-233-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 244 HARRIS BRANCH LN
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City | HAZARD
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State | KY
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Zip | 41701-8082
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 283417
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License Number State | KY
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