Provider Demographics
NPI:1407529712
Name:BROSSART, SHAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BROSSART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 RUSTY FIG DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8322
Mailing Address - Country:US
Mailing Address - Phone:281-409-7710
Mailing Address - Fax:
Practice Address - Street 1:7100 RUSTY FIG DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8322
Practice Address - Country:US
Practice Address - Phone:281-409-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health