Provider Demographics
NPI:1730486168
Name:DJ2 JUNCTIONS INC
Entity Type:Organization
Organization Name:DJ2 JUNCTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GARLITZ-BEDINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-935-8522
Mailing Address - Street 1:1200 N THORNTON ST STE J
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5508
Mailing Address - Country:US
Mailing Address - Phone:575-935-8522
Mailing Address - Fax:
Practice Address - Street 1:1200 N THORNTON ST STE J
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5508
Practice Address - Country:US
Practice Address - Phone:575-935-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0144951101Y00000X, 101YM0800X, 101YP2500X
NM0148831101YA0400X
NM0170731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51206544Medicaid
NM357783771Medicaid