Provider Demographics
NPI:1104093632
Name:TRUAN, CLYDE FRANKLIN III (PHD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:FRANKLIN
Last Name:TRUAN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2465 DEMERE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1630
Mailing Address - Country:US
Mailing Address - Phone:912-399-5414
Mailing Address - Fax:912-267-7981
Practice Address - Street 1:2465 DEMERE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1630
Practice Address - Country:US
Practice Address - Phone:912-399-5414
Practice Address - Fax:912-267-7981
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical