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General NPI Number Information
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NPI Number | 1093609315
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Entity Type | Organization
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Legal Business Name | HOMEWARD BOUND CLINIC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 395 S MAIN ST STE 202
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City | ALPINE
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State | UT
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Zip | 84004-2050
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Country | US
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Telephone | 719-466-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 5513 W 11000 N STE 316
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City | HIGHLAND
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State | UT
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Zip | 84003-8012
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Country | US
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Telephone | 719-466-0940
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL BRUCE MCCONKIE
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Credential |
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Telephone | 719-466-0940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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