Provider Demographics
NPI:1093609315
Name:HOMEWARD BOUND CLINIC
Entity type:Organization
Organization Name:HOMEWARD BOUND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MCCONKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-466-0940
Mailing Address - Street 1:5513 W 11000 N STE 316
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8012
Mailing Address - Country:US
Mailing Address - Phone:719-466-0940
Mailing Address - Fax:
Practice Address - Street 1:395 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-2050
Practice Address - Country:US
Practice Address - Phone:716-466-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty