Healthcare Provider Details

I. General information

NPI: 1386370476
Provider Name (Legal Business Name): METTA BHAVANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 BISHOPS LODGE RD
SANTA FE NM
87506-0002
US

IV. Provider business mailing address

1328 BISHOPS LODGE RD
SANTA FE NM
87506-0002
US

V. Phone/Fax

Practice location:
  • Phone: 608-561-7533
  • Fax:
Mailing address:
  • Phone: 608-561-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVIN JAMES COOGAN
Title or Position: OWNDER
Credential: LCSW
Phone: 505-231-6658