MEDICARE: RENALD LORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14192495-6004	UT

General Provider Information

NPI Number	:	1891626735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENALD LORE

Provider Business Mailing Address
First Line	:	3292 ORCHARD AVE
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-0639
Country	:	US
Telephone Number	:	385-288-9948
Fax Number	:

Provider Business Practice Location Address
First Line	:	2363 N 400 W
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-6909
Country	:	US
Telephone Number	:	801-525-4645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ RENALD LORE ” Practice Location

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