Healthcare Provider Details

I. General information

NPI: 1902161987
Provider Name (Legal Business Name): DANIEL F BROSSART PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 S TEXAS AVE
BRYAN TX
77802-3127
US

IV. Provider business mailing address

4225 TAMU
COLLEGE STATION TX
77843-4225
US

V. Phone/Fax

Practice location:
  • Phone: 979-595-1770
  • Fax:
Mailing address:
  • Phone: 979-862-4657
  • Fax: 979-862-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number30551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: