Healthcare Provider Details

I. General information

NPI: 1801711122
Provider Name (Legal Business Name): WILLIAM THOMAS BAHLKE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SUNRISE HWY STE 200
LYNBROOK NY
11563-2950
US

IV. Provider business mailing address

123 GROVE AVE STE 216
CEDARHURST NY
11516-2302
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax: 516-874-2477
Mailing address:
  • Phone: 516-350-8564
  • Fax: 516-874-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: