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General NPI Number Information
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NPI Number | 1891591293
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Entity Type | Individual
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Provider Name | BAILI ALEXIS DIEFENBACH M.ED., LPCA
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 125 EAGLE NEST DR
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City | PADUCAH
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State | KY
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Zip | 42003-9435
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Country | US
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Telephone | 270-898-1293
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Fax | 270-898-1187
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Provider Business Mailing Address
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Address Line | 230 HEATHER LN
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City | LEDBETTER
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State | KY
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Zip | 42058-9735
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Country | US
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Telephone | 618-218-8723
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 299334
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License Number State | KY
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