Provider Demographics
NPI:1831405836
Name:HOMEWARD BOUND
Entity type:Organization
Organization Name:HOMEWARD BOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMMY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:THAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:801-768-1441
Mailing Address - Street 1:770 E MAIN ST # 215
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2293
Mailing Address - Country:US
Mailing Address - Phone:801-768-1441
Mailing Address - Fax:801-705-0333
Practice Address - Street 1:770 E MAIN ST # 215
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-768-1441
Practice Address - Fax:801-705-0333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMEWARD BOUND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3683823902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty