1. Home
  2. Directory
  3. California
  4. Rohnert Park
  5. Marriage Family Therapist
  6. NPI Profile
Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION
NPI 1124957030
Marriage & Family Therapist in Rohnert Park, CA

Active since May 16, 2026
1500 VALLEY HOUSE DR STE 210, ROHNERT PARK, CA 94928(707) 782-2419(707) 715-2875 Get Directions Write a Review

NPPES record added: July 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 10, 2026, May 16, 2026 (2 updates tracked since 2026).

About Mycelium Family Therapy, Professional Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION (NPI 1124957030), doing business as Mycelium Counseling Collective, is a healthcare organization registered as a marriage & family therapist in Rohnert Park, California and active in the NPI registry since May 2026. The organization lists Lacey Lynn Palmer, President, Ceo, as its authorized official.

NPPES Registry Identity

NPI1124957030
Entity TypeOrganization
Primary Taxonomy106H00000X
Legal Business NameMYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION
Location Address1500 VALLEY HOUSE DR STE 210Rohnert Park, CA 94928-4938
Mailing Address1500 Valley House Dr Ste 210Rohnert Park, CA 94928-4938 · (707) 782-2419 · Fax (707) 715-2875
Phone(707) 782-2419
Fax(707) 715-2875
Organization SubpartNo
Authorized OfficialLacey Lynn PalmerPresident, Ceo · (707) 782-2419
Enumeration DateMay 16, 2026
Last NPPES UpdateJuly 10, 20262 updates tracked since enumeration
NPPES CertifiedJuly 10, 2026
✔ NPI 1124957030 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
1500 VALLEY HOUSE DR STE 210, Rohnert Park, CA 94928
Open in Google Maps ↗

Other Names 1

Doing Business AsMycelium Counseling Collective

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACQUELINE THERESA DAVEY CPD
Doula
1500 VALLEY HOUSE DR STE 210
ROHNERT PARK, CA 94928
Sonoma County (707) 395-5048
KYLIE DIANE HEMPY
Marriage & Family Therapist
1500 VALLEY HOUSE DR STE 210
ROHNERT PARK, CA 94928
Sonoma County (408) 458-0309
SUGAFLO PHYSICIAN ASSISTANT CORPORATION
Physician Assistant
1500 VALLEY HOUSE DR STE 210
ROHNERT PARK, CA 94928
Sonoma County (707) 477-6446

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mycelium Family Therapy, Professional Corporation's NPI number?

The NPI number for Mycelium Family Therapy, Professional Corporation is 1124957030. It was assigned to this organization in the NPPES registry on May 16, 2026. The provider is doing business as Mycelium Counseling Collective.

Where is Mycelium Family Therapy, Professional Corporation located?

Mycelium Family Therapy, Professional Corporation is located at 1500 Valley House Dr Ste 210, Rohnert Park, CA 94928. The listed phone number is (707) 782-2419.

What is Mycelium Family Therapy, Professional Corporation's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

When was this NPI record last updated?

The NPPES record for Mycelium Family Therapy, Professional Corporation was last updated on July 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 27 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.