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Mycelium Family Therapy, Professional Corporation

Marriage & Family Therapist in Rohnert Park, CA · enumerated 2026 · authorized official Lacey Palmer, President, Ceo.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1124957030

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Registry record

Entity type Organization (Type 2)
Legal business name Mycelium Family Therapy, Professional Corporation
Practice address 1500 Valley House Dr Ste 210, Rohnert Park, CA, 94928
Phone (707) 782-2419
Fax (707) 715-2875
Enumeration date May 16, 2026
Last updated in NPPES Jul 10, 2026

Taxonomy & classification

106H00000X Marriage & Family Therapist Behavioral Health & Social Service Providers Primary

Authorized official

Name Lacey Palmer
Title President, Ceo
Phone (707) 782-2419

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Mycelium Family Therapy, Professional Corporation?
The NPI for Mycelium Family Therapy, Professional Corporation is 1124957030, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Mycelium Family Therapy, Professional Corporation?
NPPES lists Lacey Palmer (President, Ceo) as the authorized official for this organization.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2026-07-10.