Provider Demographics
NPI:1962553701
Name:JORE, RENEE' MARIE (LMFT, LADC)
Entity type:Individual
Prefix:
First Name:RENEE'
Middle Name:MARIE
Last Name:JORE
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3104
Mailing Address - Country:US
Mailing Address - Phone:218-327-2001
Mailing Address - Fax:218-327-0456
Practice Address - Street 1:717 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3104
Practice Address - Country:US
Practice Address - Phone:218-327-2001
Practice Address - Fax:218-327-1456
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1451106H00000X
MN301946101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27511800Medicaid