Healthcare Provider Details

I. General information

NPI: 1184041014
Provider Name (Legal Business Name): ENDURANCE- A SPORTS AND PSYCHOLOGY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST STE 201
BERKELEY CA
94705-1147
US

IV. Provider business mailing address

PO BOX 215210
SACRAMENTO CA
95821-1210
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-1471
  • Fax: 844-630-3965
Mailing address:
  • Phone: 510-981-1471
  • Fax: 844-630-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 20441
License Number StateCA

VIII. Authorized Official

Name: DR. CORY M. NYAMORA
Title or Position: PRESIDENT
Credential: PSYD.
Phone: 510-981-1471