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General NPI Number Information
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NPI Number | 1134024185
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Entity Type | Organization
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Legal Business Name | CREATORS LEGACY LLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 6541 S COTTONWOOD ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-7007
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Country | US
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Telephone | 801-946-2323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | RIGBY
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State | ID
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Zip | 83442-0038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | GARRETT FOSTER
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Credential |
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Telephone | 208-317-8598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | NULL
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Taxonomy #6
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | NULL
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