Charlie Ray Hystad-Moe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5334 Issued in ND

Practice address

2224 1St Ave W Ste 4
Williston, ND 58801-6286

Phone

(701) 572-3335

Fax

(701) 572-3337

NPI assigned

Apr 26, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Caldera Therapy, PLLC

  • Clinical Social Worker
  • Williston, ND
  • NPI 1457218216
  NPD Authorized official
• Katie Shannon Licsw LLC

  • Clinical Social Worker
  • Williston, ND
  • NPI 1265091235
  NPD
• Williams County Social Services

  • Case Manager/Care Coordinator
  • Williston, ND
  • NPI 1093213464
  NPD (past)
• Williams County Social Services

  • Case Management Agency
  • Williston, ND
  • NPI 1578980272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768089600000",
    "number": "1407344286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 4",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-572-3335",
            "fax_number": "701-572-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 1ST AVE W STE 4",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016286",
            "telephone_number": "701-572-3335",
            "fax_number": "701-572-3337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5598 145th Ave NW",
            "address_purpose": "LOCATION",
            "city": "Williston",
            "state": "ND",
            "postal_code": "588019033",
            "country_code": "US",
            "telephone_number": "701-695-2226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HYSTAD-MOE",
        "first_name": "CHARLIE",
        "middle_name": "RAY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2026-01-11",
        "certification_date": "2026-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "5334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tory Huey, DC
• Brandon Lee Hunter, M.S
• Caitlyn Hunter, M.S., SLP
• Chris Huravitch, P.T., D.P.T
• Kimberly Ann Hustad
• Ideal Option, PLLC
• Ideal Telemedicine Services
• Implant&Maxillofacial Surgical Center
• Interstate Retail Inc
• Jill Iverson, RN

• Clinical Social Worker in Williston, ND
• Providers in Williston, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.