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Organization
CREATORS LEGACY OF MIDVALE LLC
Active
Organization
CREATORS LEGACY OF MIDVALE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOSEPH VICARIO CMHC (CLINICAL DIRECTOR)
(801) 946-2323
Entity
Organization
Contact information
Practice address
6541 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-7007
(801) 946-2323
Mailing address
636 S 40 E, SALEM, UT 84653-9530
(801) 946-2323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
NULL
175T00000X
Peer Specialist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
NULL
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
Other
Enumeration date
07/22/2026
Last updated
07/22/2026
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