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General NPI Number Information
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NPI Number | 1184041014
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Entity Type | Organization
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Legal Business Name | ENDURANCE- A SPORTS AND PSYCHOLOGY CENTER, INC.
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 2340 WARD ST STE 201
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City | BERKELEY
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State | CA
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Zip | 94705-1147
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Country | US
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Telephone | 510-981-1471
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Fax | 844-630-3965
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Provider Business Mailing Address
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Address Line | PO BOX 215210
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City | SACRAMENTO
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State | CA
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Zip | 95821-1210
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Country | US
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Telephone | 510-981-1471
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Fax | 844-630-3965
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CORY M. NYAMORA
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Credential | PSYD.
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Telephone | 510-981-1471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 20441
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License Number State | CA
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