# CALDERA THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457218216
- **Authorized official:** CHARLIE RAY HYSTAD-MOE LAC, LCSW (MENTAL HEALTH THERAPIST)
- **Authorized official phone:** (701) 570-4027

## Contact information

- **Practice address:** 5598 145TH AVE NW, WILLISTON, ND 58801-9033
- **Practice address phone:** (701) 570-4027
- **Mailing address:** 5598 145TH AVE NW, WILLISTON, ND 58801-9033
- **Mailing address phone:** (701) 570-4027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2026
- **Last updated:** 01/05/2026