Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mycelium Family Therapy, Professional Corporation

Organization Marriage & Family Therapist · NPI 1124957030

Mycelium Family Therapy, Professional Corporation is a Marriage & Family Therapist in Rohnert Park, California. Registered with an NPI since 2026.

In the registry since
2026

Practice location Address checks out

1500 Valley House Dr Ste 210
Rohnert Park, CA 94928-4938
Phone: (707) 782-2419
Fax: (707) 715-2875
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X

Record details

NPI number1124957030
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lacey Palmer — President, Ceo · (707) 782-2419
Other names Mycelium Counseling Collective
NPI enumeratedMay 16, 2026
Last updated in NPPESJuly 10, 2026
Certification dateJuly 10, 2026
Mailing address1500 Valley House Dr Ste 210, Rohnert Park, CA 94928-4938

Other providers in Rohnert Park