Mycelium Family Therapy, Professional Corporation

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION

Practice address

1500 Valley House Dr Ste 210
Rohnert Park, CA 94928-4938

Phone

(707) 782-2419

Fax

(707) 715-2875

NPI assigned

May 16, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lacey Lynn Palmer, PHD, LMFTNPI 1114436060

Title

President, Ceo

Phone

(707) 782-2419

Specialties & licenses 1

Addresses

Other names 1

• Mycelium Counseling Collective Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lacey Lynn Palmer

  • Marriage & Family Therapist
  • Cotati, CA
  • NPI 1114436060
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1778889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1124957030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 VALLEY HOUSE DR STE 210",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949284938",
            "telephone_number": "707-782-2419",
            "fax_number": "707-715-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 VALLEY HOUSE DR STE 210",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949284938",
            "telephone_number": "707-782-2419",
            "fax_number": "707-715-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-16",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LACEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "707-782-2419",
        "authorized_official_credential": "PHD, LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mycelium Counseling Collective",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cynthia Morfin
• Mkenna Catheryn Mosby
• Joseph Mulindwa
• Christopher Robert Murolo
• Sarah A Murphy, M.D.
• Jaime Myers Garrity
• Sean Nadalin, PA
• Nader M. Vafaie DMD MMSC Professional Corp
• Sarah Marie Nagy, BCAT
• Flor Angelica Nanu

• Marriage & Family Therapist in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.