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General NPI Number Information
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NPI Number | 1386370476
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Entity Type | Organization
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Legal Business Name | METTA BHAVANA LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 1328 BISHOPS LODGE RD
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City | SANTA FE
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State | NM
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Zip | 87506-0002
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Country | US
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Telephone | 608-561-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 BISHOPS LODGE RD
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City | SANTA FE
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State | NM
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Zip | 87506-0002
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Country | US
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Telephone | 608-561-7533
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | DEVIN JAMES COOGAN
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Credential | LCSW
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Telephone | 505-231-6658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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