Provider Demographics
NPI:1891591293
Name:DIEFENBACH, BAILI ALEXIS (MED, LPCA)
Entity type:Individual
Prefix:
First Name:BAILI
Middle Name:ALEXIS
Last Name:DIEFENBACH
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:LEDBETTER
Mailing Address - State:KY
Mailing Address - Zip Code:42058-9735
Mailing Address - Country:US
Mailing Address - Phone:618-218-8723
Mailing Address - Fax:
Practice Address - Street 1:125 EAGLE NEST DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9435
Practice Address - Country:US
Practice Address - Phone:270-898-1293
Practice Address - Fax:270-898-1187
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY299334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator