Healthcare Provider Details

I. General information

NPI: 1972623874
Provider Name (Legal Business Name): NORI BOKUM, M.A., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N MAIN ST SUITE 30
WHITE RIVER JUNCTION VT
05001-6200
US

IV. Provider business mailing address

PO BOX 108
NORWICH VT
05055-0108
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-7500
  • Fax:
Mailing address:
  • Phone: 802-295-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number047-0000634
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number047-0000634
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number047-0000634
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number047-0000634
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number047-0000634
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number047-0000634
License Number StateVT
# 7
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number047-0000634
License Number StateVT

VIII. Authorized Official

Name: MR. NORI BOKUM
Title or Position: PRESIDENT
Credential: M.A.
Phone: 802-295-7500