Provider Demographics
NPI:1043057854
Name:MADE FOR MORE, LLC
Entity type:Organization
Organization Name:MADE FOR MORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER, MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OTHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-812-0724
Mailing Address - Street 1:82 WENDELL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7066
Mailing Address - Country:US
Mailing Address - Phone:508-812-0724
Mailing Address - Fax:
Practice Address - Street 1:5 MERINO ST APT 2
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-2845
Practice Address - Country:US
Practice Address - Phone:508-812-0724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health