Healthcare Provider Details

I. General information

NPI: 1891626735
Provider Name (Legal Business Name): RENALD LORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 N 400 W
LAYTON UT
84041-6909
US

IV. Provider business mailing address

3292 ORCHARD AVE
OGDEN UT
84403-0639
US

V. Phone/Fax

Practice location:
  • Phone: 801-525-4645
  • Fax:
Mailing address:
  • Phone: 385-288-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14192495-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: