Provider Demographics
NPI:1124802590
Name:GAGE, CAMERON WAYNE (LPCC)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:WAYNE
Last Name:GAGE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10190 BANNOCK ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6052
Mailing Address - Country:US
Mailing Address - Phone:254-541-6065
Mailing Address - Fax:
Practice Address - Street 1:7200 QUEBEC PKWY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-4824
Practice Address - Country:US
Practice Address - Phone:303-289-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC0020404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health