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General NPI Number Information
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NPI Number | 1831405836
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Entity Type | Organization
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Legal Business Name | HOMEWARD BOUND
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 770 E MAIN ST # 215
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City | LEHI
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State | UT
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Zip | 84043
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Country | US
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Telephone | 801-768-1441
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Fax | 801-705-0333
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Provider Business Mailing Address
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Address Line | 770 E MAIN ST # 215
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City | LEHI
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State | UT
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Zip | 84043-2293
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Country | US
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Telephone | 801-768-1441
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Fax | 801-705-0333
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Authorized Official
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Title or Position | CEO
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Name | DR. TIMMY RYAN THAYNE
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Credential | MFT
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Telephone | 801-768-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3683823902
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License Number State | UT
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