Organization
CREATORS LEGACY HOMES 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
332 W HARVARD DR, MIDVALE, UT 84047-7582
(801) 946-2323
Mailing address
636 S 40 E, SALEM, UT 84653-9530
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/22/2026
Last updated
07/22/2026
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