Organization Active NPI

Mycelium Mental Health PLLC

  • Psychiatry Physician
  • Libertyville, IL
National Provider Identifier
1245129170
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MYCELIUM MENTAL HEALTH PLLC
Practice address
1590 S Milwaukee Ave Ste 210
Libertyville, IL 60048-3785
Phone
(847) 637-7516
NPI assigned
Jul 3, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
Wendy You, MDNPI 1073005302
Title
Psychiatrist
Phone
(847) 637-7516

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1590 S Milwaukee Ave Ste 210
Libertyville, IL 60048-3785

Mailing address

PO Box 5970
Vernon Hills, IL 60061-5970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260106003837 IL Part B Supplier - Clinic/Group Practice 9234625567 Receives reassigned benefits from 1 practitioner
Practice locations: Libertyville, IL

National Provider Directory

National Provider Directory

Locations

1590 S Milwaukee Ave
Ste 210
Libertyville, IL 60048
Phone (847) 564-3862

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1751500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1245129170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5970",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600615970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 S MILWAUKEE AVE STE 210",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483785",
            "telephone_number": "847-637-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCELIUM MENTAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-03",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "YOU",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "847-637-7516",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.