Healthcare Provider Details

I. General information

NPI: 1730486168
Provider Name (Legal Business Name): DJ2 JUNCTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N THORNTON ST STE J
CLOVIS NM
88101-5508
US

IV. Provider business mailing address

1200 N THORNTON ST STE J
CLOVIS NM
88101-5508
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-8522
  • Fax:
Mailing address:
  • Phone: 575-935-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0144951
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0148831
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0170731
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0144951
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0144951
License Number StateNM

VIII. Authorized Official

Name: DELLA DAWN GARLITZ-BEDINGFIELD
Title or Position: CEO/PRESIDENT
Credential:
Phone: 575-935-8522