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General NPI Number Information
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NPI Number | 1770404279
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Entity Type | Organization
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Legal Business Name | CREATORS LEGACY HOMES LLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 332 W HARVARD DR
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City | MIDVALE
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State | UT
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Zip | 84047-7582
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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 | 636 S 40 E
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City | SALEM
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State | UT
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Zip | 84653-9530
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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 | CLINICAL DIRECTOR
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Name | MATTHEW JOSEPH VICARIO
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Credential | CMHC
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Telephone | 801-946-2323
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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 |
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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 |
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Taxonomy #3
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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 |
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Taxonomy #4
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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 |
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