# CREATORS LEGACY OF MIDVALE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346161866
- **Authorized official:** MATTHEW JOSEPH VICARIO CMHC (CLINICAL DIRECTOR)
- **Authorized official phone:** (801) 946-2323

## Contact information

- **Practice address:** 6541 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-7007
- **Practice address phone:** (801) 946-2323
- **Mailing address:** 636 S 40 E, SALEM, UT 84653-9530
- **Mailing address phone:** (801) 946-2323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 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