Provider Demographics
NPI:1366167116
Name:GONZALES, CAMERON RAY (MFT-C)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:RAY
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 BROADWAY STE 314C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5233
Mailing Address - Country:US
Mailing Address - Phone:720-767-2229
Mailing Address - Fax:
Practice Address - Street 1:12211 W ALAMEDA PKWY STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2825
Practice Address - Country:US
Practice Address - Phone:720-767-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist