Organization
CALDERA THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE RAY HYSTAD-MOE LAC, LCSW (MENTAL HEALTH THERAPIST)
(701) 570-4027
Entity
Organization
Contact information
Practice address
5598 145TH AVE NW, WILLISTON, ND 58801-9033
(701) 570-4027
Mailing address
5598 145TH AVE NW, WILLISTON, ND 58801-9033
(701) 570-4027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/05/2026
Last updated
01/05/2026
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