Provider Demographics
NPI:1902161987
Name:BROSSART, DANIEL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:BROSSART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 TAMU
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-4225
Mailing Address - Country:US
Mailing Address - Phone:979-862-4657
Mailing Address - Fax:979-862-1256
Practice Address - Street 1:3370 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3127
Practice Address - Country:US
Practice Address - Phone:979-595-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling