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Organization
MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION
Active
Organization
MYCELIUM FAMILY THERAPY, PROFESSIONAL CORPORATION
Active
Other names
Mycelium Counseling Collective
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY LYNN PALMER PHD, LMFT (PRESIDENT, CEO)
(707) 782-2419
Entity
Organization
Contact information
Practice address
1500 VALLEY HOUSE DR STE 210, ROHNERT PARK, CA 94928-4938
(707) 782-2419
(707) 715-2875
Mailing address
1500 VALLEY HOUSE DR STE 210, ROHNERT PARK, CA 94928-4938
(707) 782-2419
(707) 715-2875
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
05/16/2026
Last updated
07/10/2026
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